Remote Appeals & Grievances Specialist

Acentra Health, LLC; Oregon; Hybrid; USD 42,000 - 52,000; Full time

Job summary

Acentra Health is seeking an Appeals and Grievance Specialist to join our growing team. You will conduct thorough research and investigations to resolve complaints and appeals, oversee outcomes, and ensure prompt completion of the process. This is remote with core hours in the Eastern Time Zone.

Required: high school diploma or GED. Associate's degree and 1+ year in customer service preferred. Proficiency in MS Word and Outlook, strong written and verbal communication, and solid organizational

Qualifications

• Experience in handling complaints and appeals in a healthcare or similar setting.
• Ability to research and investigate to resolve issues.
• Strong written and verbal communication skills.

Responsibilities

• Assign, track, and triage cases across appeal levels.
• Prepare and send acknowledgment letters to members and providers.
• Document inquiries and outcomes in the case management system.
• Resolve cases within regulatory timeframes and established SLAs.
• Adhere to HIPAA and Privacy rules.
• Collaborate with teams to ensure proper escalation and resolution.

Skills

Customer service

Written communication

Verbal communication

Interpersonal skills

Organizational skills

Attention to detail

Education

High school diploma or GED

Associate's degree (preferred)

Tools

MS Word

Outlook

Job description

Acentra Health is seeking an Appeals and Grievance Specialist to join our growing team. You will conduct thorough research and investigations to resolve complaints and appeals, oversee outcomes, and ensure prompt completion of the process. This is remote with core hours in the Eastern Time Zone.

Required: high school diploma or GED. Associate's degree and 1+ year in customer service preferred. Proficiency in MS Word and Outlook, strong written and verbal communication, and solid organizational