Grievances & Appeals Specialist I (Health Claims)

Blue Cross of Idaho; Meridian (MS); On-site; USD 33,000 - 46,000; Full time

Benefits offered by this job

Paid time off

Paid holidays

Community service days

Medical/dental/vision/pharmacy

401(k) matching

Life insurance

Short and long term disability

Education reimbursement

Employee assistance plan (EAP)

Adoption assistance program

Paid family leave program

Job summary

Blue Cross of Idaho is seeking a Grievance & Appeals Specialist I to classify and prepare detailed case histories for committee review. You will determine information needs, apply policy and contract rules, and present appeal cases for independent review and cross-department consultation.

The role requires medical terminology knowledge and familiarity with ICD-10 and CPT coding, plus experience with individual and group contract language. Strong communication is essential.

Qualifications

• Strong verbal and written communication skills.
• Familiarity with medical terminology and coding systems (ICD-10, CPT).
• Experience with Individual and Group contract language or contracts.
• Customer service or claims processing experience preferred.
• Ability to interpret policies, rules, and business contracts.

Responsibilities

• Classify and categorize grievance cases accurately.
• Prepare comprehensive case histories for committee meetings and audits.
• Determine if additional information is needed to make decisions.
• Interpret and apply business rules, policies, and contract language.
• Prepare appeal cases for independent review and present to a multi-department committee.

Skills

Verbal & Written Communication

Medical Terminology

ICD-10 / CPT Coding

Contract Language (Ind/Grp)

Customer Service / Claims Experience

Job description

Blue Cross of Idaho is seeking a Grievance & Appeals Specialist I to classify and prepare detailed case histories for committee review. You will determine information needs, apply policy and contract rules, and present appeal cases for independent review and cross-department consultation.

The role requires medical terminology knowledge and familiarity with ICD-10 and CPT coding, plus experience with individual and group contract language. Strong communication is essential.