Specialist, Admin Complaints, Grievances & Appeals

📋 Description

• Follow established workflows to log initial assessment on complex or escalated administrative
• Conduct multi-faceted investigations by gathering and analyzing internal data, call logs, and
• Use workflows to reconstruct complex event timelines involving prior authorizations, claims
• Collaborate with internal departments (Member Services, Eligibility & Benefits, Claims) to
• Based on investigative findings, determine a resolution strategy that is fair and compliant with
• Escalate issues to leadership for further guidance on resolution strategy.

🎯 Requirements

• 1+ years of professional experience in a regulated industry (healthcare, insurance, or finance).
• 1+ years of experience independently managing a demanding caseload with multi-step workflows from
• 1+ years of experience directly managing escalated customer, member, or provider cases.
• 1+ years of experience drafting and issuing formal written communication to members and providers.
• 1+ years of experience working in a structured, workflow-driven environment.

🎁 Benefits

• Medical, dental, and vision benefits
• 11 paid holidays
• Paid sick time
• Paid parental leave
• 401(k) plan participation
• Life and disability insurance