Member Appeals Specialist

Job Summary

A company is looking for a Member Appeals Specialist to support the intake, processing, and resolution of member pre-service pharmacy appeals for non-Medicare products.

Key Responsibilities

• Triage incoming appeals and grievances by categorizing and assigning them to appropriate team members
• Manage the full lifecycle of each appeal case, including eligibility validation and accurate documentation
• Coordinate with internal stakeholders to ensure workflow requirements are met and prepare compliant appeal decision notices

Required Qualifications

• Previous experience managing member appeals
• Familiarity with appeal case management platforms
• Reliable and detail-oriented with a proactive approach
• Comfortable working in a fully remote environment
• Able to balance multiple tasks while meeting time-sensitive deadlines