Remote Appeals & Grievance Specialist

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

Job summary

Acentra Health is seeking an Appeals & Grievance Specialist to join our growing team. The specialist conducts thorough research and investigations to aid in resolving complaints and appeals and oversees outcomes to ensure timely completion of the process.

This is a remote role with core hours in the Eastern Time Zone, offering flexibility while maintaining regulatory compliance and delivering service to members, providers, and agencies.

Qualifications

• Requires high school diploma or GED.
• Associate's degree preferred.
• 1+ years' experience in customer service in healthcare is preferred.
• Proficient in MS Word and Outlook.

Responsibilities

• Assign mail cases to correct area based on appeal level.
• Send verbal and written correspondence to members, providers, and agencies.
• Document and log inquiry, appeal, and complaint information.
• Resolve cases within required turnaround times.
• Ensure proper resolution within regulatory timelines; follow HIPAA policies.

Skills

Customer service

Written/verbal communication

Interpersonal skills

Data entry

Education

High school diploma

Associate's degree preferred

Tools

MS Word

Outlook

Job description

Acentra Health is seeking an Appeals & Grievance Specialist to join our growing team. The specialist conducts thorough research and investigations to aid in resolving complaints and appeals and oversees outcomes to ensure timely completion of the process.

This is a remote role with core hours in the Eastern Time Zone, offering flexibility while maintaining regulatory compliance and delivering service to members, providers, and agencies.