Appeals Specialist

Position Purpose: Supports the documentation and processing of appeals, disputes and reconsiderations to ensure they are in accordance with state and National Committee for Quality Assurance (NCQA) requirements. Support the team to ensure appeals, disputes and reconsiderations are reviewed and processed timely. Key Details: This fully remote Appeals Specialist position is open to candidates anywhere in the U.S. and requires working Eastern Time hours, 8:30 AM to 5:00 PM ET. The ideal candidate has experience with appeals, grievances, claims, or other regulated casework and can independently manage complex cases in a fast-paced, deadline-driven environment. No license or certification is required. Performs data entry to support the tracking, logging, and processing of appeals, disputes and reconsiderations in accordance with established regulatory and accreditation guidelines and procedures Prepares correspondence for appeals, disputes and reconsiderations and maintains documentation files Reviews and investigates appeals, disputes and reconsiderations requests to determine applicable follow up Conducts research needed to evaluate, process, and respond to appeals, disputes and reconsiderations to ensure a timely decision Prepares case files including supporting documentation and determinations needed to review, process, and report the appeals, disputes and reconsiderations Gathers appeals, disputes and reconsiderations data to track and report on trends and final outcomes to t