Remote Appeals & Grievances Specialist

Network Health; Menasha (WI); Remote; USD 52,000 - 70,000; Full time

Job summary

Network Health is seeking an Appeals and Grievance Specialist I to join our Wisconsin team. The role reviews member appeals, investigates findings, and prepares determinations in a compliant, collaborative environment.

The position requires at least two years in a health insurance setting, with strong communication and regulatory interpretation skills. Remote 1.0 FTE, with occasional travel to offices in Menasha or Brookfield.

Qualifications

• Two years of experience in health insurance or related field.
• Experience with Medicare, ERISA or related regulations preferred.
• Ability to interpret plans and regulations.

Responsibilities

• Fully reviews appeals and grievances to determine needed documentation.
• Compile and reconcile documentation with internal teams and providers.
• Communicate appeals status to members and gather missing info.
• Investigate, summarize findings, and obtain resolution within regulatory timeframes.
• Document investigations and notifications in the database.

Skills

Communication skills

Regulatory research

Customer service

Education

High School diploma or equivalent

Associates degree preferred

Tools

Microsoft Word

Microsoft Excel

Job description

Network Health is seeking an Appeals and Grievance Specialist I to join our Wisconsin team. The role reviews member appeals, investigates findings, and prepares determinations in a compliant, collaborative environment.

The position requires at least two years in a health insurance setting, with strong communication and regulatory interpretation skills. Remote 1.0 FTE, with occasional travel to offices in Menasha or Brookfield.