Appeals, Complaints and Grievances Specialist

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.

Responsible for intake, investigation and resolution of appeals, complaints and grievances scenarios for all products. You will ensure timely, customer-focused responses to appeals, complaints and grievances, identifying trends and emerging issues, and recommending solutions.

Key Responsibilities:

• Research incoming electronic appeals, complaints and grievances to identify if they're appropriate for your unit.
• Verify accuracy of benefit/administrative denials, claim payments, and member eligibility data.
• Coordinate responses from multiple business units and communicate final resolutions to members/providers.
• Serve as a technical resource to colleagues on appeals, complaints and grievance issues.
• Identify trends and emerging issues, reporting and giving input on potential solutions.

Requirements:

• Experience in reading or researching benefit language.
• 1-2 years of experience in claim platforms, products, benefits, patient management, or related fields.
• Strong analytical skills, attention to detail, and excellent verbal and written communication skills.
• Computer literacy in Excel, Microsoft Word, and internal/external computer systems.

Preferred Qualifications:

• Experience in research and analysis of claim processing.

Benefits:

• Comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, and wellness programs.

Salary Range: $17.00 - $25.65 per hour