Member Appeals Specialist

Job Summary

A company is looking for a Member Appeals Specialist (Remote).

Key Responsibilities

• Triage and assign incoming appeals and grievances, ensuring proper categorization
• Manage 40+ active member pharmacy appeals with regulatory timeliness
• Draft and issue compliant acknowledgement and decision notices using templates

Required Qualifications

• Experience with member appeals, particularly pre-service pharmacy (non-Medicare)
• Skilled in managing caseloads within appeals systems like Jiva
• Reliable, detail-focused, and engaged in virtual work environments
• Willingness to learn and apply reference materials to ensure compliance