Remote Appeals & Grievance Specialist

Acentra Health, LLC; Maine; Remote; USD 28,000 - 35,000; Full time

Job summary

Acentra Health is seeking an Appeals & Grievance Specialist to join our team. This remote role has core hours in the Eastern Time Zone and involves researching, investigating, and resolving complaints and appeals to ensure prompt closures.

You will manage cases, communicate with members and providers, and log all actions while adhering to HIPAA and corporate policies. Prior healthcare/customer service experience is preferred.

Qualifications

• Requires high school diploma or GED.
• Associate's degree preferred.
• 1+ years' experience in customer service required.
• Previous experience in the health care industry preferred.

Responsibilities

• Assign mail cases to the correct area based on the level of appeal (admin, clinical, external).
• Verbal and written correspondence to customers (members, providers, agencies).
• Document and log inquiry, appeal, and complaint information.
• Resolve cases within required timeframes to meet turnaround times.
• Ensure proper resolution within regulatory or customer timelines.
• Adhere to HIPAA and related privacy and security rules.

Skills

High school diploma

Associate's degree

Customer service

Healthcare experience

MS Word

Outlook

Critical thinking

Interpersonal skills

Data entry

Customer service skills

Education

High school diploma or GED

Associate's degree

Tools

MS Word

Outlook

Job description

Acentra Health is seeking an Appeals & Grievance Specialist to join our team. This remote role has core hours in the Eastern Time Zone and involves researching, investigating, and resolving complaints and appeals to ensure prompt closures.

You will manage cases, communicate with members and providers, and log all actions while adhering to HIPAA and corporate policies. Prior healthcare/customer service experience is preferred.