Member Appeals & Grievances Specialist I

Viva-Health; Birmingham (AL); On-site; USD 42,000 - 54,000; Full time

Benefits offered by this job

Health, Vision & Dental Coverage

401(k) with company match

Paid Time Off (PTO)

9 Paid Holidays + Floating Holiday

Tuition Assistance

Flexible Spending Accounts

Life Insurance and Disability Coverage

Employee Wellness Program

Job summary

Viva Health in Birmingham is seeking a Member Appeals & Grievances Specialist to analyze and resolve Medicare appeals and grievances from members, providers, and government entities. You will coordinate timely resolutions per state/federal guidelines and Viva Health policies, and contribute to audits.

Role requires working at Viva Health HQ in downtown Birmingham with an option to work one day per week from home after training. Weekend/holiday on-call participation is required.

Qualifications

• High School diploma or GED required.
• 1–3 years in managed care, health care customer service, or appeals/grievances.
• Excellent written and verbal communication skills.
• Ability to follow processes in sequential order.
• Ability to meet productivity, schedule adherence, and quality standards.
• Knowledge of Microsoft Office applications.
• Ability to use critical thinking to solve non-clinical issues.

Responsibilities

• Process member and non-contracted provider Medicare Part C and Part D grievances and appeals per regulations and internal policies.
• Collaborate with internal and external subject matter experts for benefit/clinical interpretations.
• Identify opportunities for training, process improvement, and better customer satisfaction.
• Act as a subject matter expert on grievances and appeals.
• Prepare for and participate in all required audits.
• Participate in on-call rotation on weekends and holidays.

Skills

Communication skills

Organizational skills

Multi-tasking

Critical thinking

Time management

Process adherence

Education

High School diploma or GED

Tools

Microsoft Office

Job description

Job Category: Operations

Requisition Number: MEMBE003067

• Posted : August 6, 2026
• Full-Time

Locations

Showing 1 location

Bham-Corporate Office
417 20th Street North
Suite 1100
Birmingham, AL 35203, USA

Bham-Corporate Office
417 20th Street North
Suite 1100
Birmingham, AL 35203, USA

Work Schedule: This position will primarily work from the VIVA HEALTH headquarters in downtown Birmingham. After training has been completed, there would be an opportunity to work 1 day per week from home.

Job Summary

The Member Appeals & Grievances Specialist will analyze and resolve all Medicare appeals and grievances received from members, non-contracted providers and government entities. This role will coordinate a timely resolution according to state and federal guidelines and VIVA HEALTH policies and procedures. This position will participate in an on-call rotation to process appeals and grievances on weekends and holidays.

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

• Comprehensive Health, Vision, and Dental Coverage
• 401(k) Savings Plan with company match and immediate vesting
• Paid Time Off (PTO)
• 9 Paid Holidays annually plus a Floating Holiday to use as you choose
• Tuition Assistance
• Flexible Spending Accounts
• Community Service Time Off
• Life Insurance and Disability Coverage
• Employee Wellness Program
• Training and Development Programs to develop new skills and reach career goals
• Process member and non-contracted provider Medicare Part C and Part D grievances and appeals according to federal and state regulations and internal, organizational policies and procedures.
• Collaborate with internal and external subject matter experts to obtain benefit and/or clinical opinions/interpretations.
• Identify training, process improvement, and other ways to maximize plan performance and customer satisfaction.
• Act as subject matter expert regarding grievances and appeals.
• Prepare for and participate in all required audits.
• Participate in on-call rotation on weekends and holidays.

REQUIRED QUALIFICATIONS:

• High School diploma or GED
• 1 – 3 years’ experience in managed care, health care customer service, or appeals and grievances
• Excellent written and verbal communication skills, interpersonal skills, organization skills, and the ability to handle multiple tasks
• Ability to carefully follow processes in sequential order
• Ability to meet established productivity, schedule adherence, and quality standards
• Knowledge of computer platforms and applications of Microsoft Office
• Ability to use critical thinking skills to develop solutions to non-clinical issues using fact-based decision making
• Ability to work occasional planned and unplanned overtime to meet deadlines with minimal supervision

PREFERRED QUALIFICATIONS:

• Experience working with the elderly population
• 1 – 3 years’ experience processing Medicare appeals and grievances
• Knowledge of Medicare regulations
• Experience with administrative and/or coordinator positions with exposure to PHI

Qualifications

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Education

Experience

Licenses & Certifications

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.