Appeals and Grievances Specialist at Network Health · United States · Joined
NH
Appeals and Grievances Specialist
Network Health · United States · Just now · 0 applicants
NewRemoteFull-timeMiddle
Pay
Pay not listed
Workplace
Remote
Job type
Full-time
Level
Middle
Source: jobright · Posted by joined-scrapper
About the role
Network Health seeks an Appeals and Grievance Specialist I to investigate and resolve member appeals and grievances, gather documentation, prepare determination summaries, and communicate with members while meeting regulatory timeframes.
What you’ll do
Review and investigate member appeals and grievances
Gather supporting documentation
Prepare determination summaries
Communicate with members
Coordinate case resolutions
Ensure compliance with applicable regulations and required timeframes
What you’ll need
Minimum of two years of experience working for a health insurance carrier or similar environment
Excellent communication skills
Ability to interpret insurance plans and regulations
Strong Word and Excel skills and ability to research regulations
High School diploma or equivalent
Prior experience with state and federal regulations such as Medicare, ERISA, and OCI regulations preferred
Original job description
Network Health is hiring an Appeals and Grievance Specialist I to review and investigate member appeals and grievances, gather supporting documentation, and prepare determination summaries. The role also communicates with members and coordinates case resolutions in accordance with applicable regulations and required timeframes.A minimum of two years of…