Claims Appeals Specialist - job 1 of 2

Job Summary

A company is looking for a Claims Appeals Specialist.

Key Responsibilities:

• Research contractual benefits and claim details to assist clinical staff with appeals and grievances
• Prioritize and analyze complex appeals, ensuring timely data entry and documentation management
• Collaborate with internal teams and external stakeholders to support case analysis and process improvements

Required Qualifications:

• 2+ years of experience in healthcare appeals, claims, or grievance resolution
• Strong knowledge of Medicaid/Medicare or other Government Program regulations
• Proficient in reading and interpreting medical documentation and insurance policies
• Experience using health plan systems for appeals intake and tracking