Grievances & Appeals Specialist I - Investigative & Policy-Driven

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

Benefits offered by this job

Paid time off

Paid holidays

Insurance (medical/dental/vision/pharm

401(k) matching

Life insurance

Disability insurance (short/long term)

Education reimbursement

Employee assistance plan (EAP)

Adoption assistance

Paid family leave

Community service days

Self-care days

Job summary

Blue Cross of Idaho is seeking a Grievance & Appeals Specialist I to serve as the primary investigator for member appeals and grievances. You will analyze, research, and manage inventories, ensuring responses comply with regulatory requirements and plan policy.

The role requires 3 years of health industry experience and offers an annual incentive bonus based on performance. A robust benefits package is provided including PTO, insurance, 401(k) matching, and more.

Qualifications

• Minimum 3 years health industry or related experience.
• Strong verbal and written communication skills.
• Knowledge of ICD-10 and CPT coding.
• Experience with Individual and Group Contract language.
• Customer service or claims processing experience preferred.

Responsibilities

• Ensure cases are accurately classified and categorized.
• 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.
• Prepare appeal cases to send to independent reviewer.
• Present appeal information to a multi-department committee.

Skills

Verbal communication

Written communication

Medical terminology

ICD-10 / CPT coding

Contract language knowledge

Customer service

Claims processing

Job description

Blue Cross of Idaho is seeking a Grievance & Appeals Specialist I to serve as the primary investigator for member appeals and grievances. You will analyze, research, and manage inventories, ensuring responses comply with regulatory requirements and plan policy.

The role requires 3 years of health industry experience and offers an annual incentive bonus based on performance. A robust benefits package is provided including PTO, insurance, 401(k) matching, and more.