Remote Grievance & Appeals Specialist

Workday; United States; Remote; USD 25,000 - 47,000; Full time

Job summary

Workday is seeking a Grievance & Appeal Specialist to address appeals within required timeframes and ensure contractual obligations are met. The role centers on accurate claims handling and timely resolutions in a fast-paced healthcare environment.

You will maintain, revise, and implement Policies and Procedures to ensure compliance with regulatory standards. This remote position requires strong communication, confidentiality, and the ability to work independently within a national telecommute

Qualifications

• Minimum two years of medical claims experience in health insurance.
• Strong problem solving, critical thinking, and investigation skills.
• Proficient with MS Word, Excel, Outlook.
• Excellent verbal and written communication.
• Ability to work independently with minimal supervision.
• Maintain confidentiality and handle time-sensitive tasks.

Responsibilities

• Address and handle appeals within specified timeframes.
• Maintain, revise, and implement Policies and Procedures to ensure compliance with regulatory standards and contractual obligations.
• Collaborate with team members, providers, and staff as needed.
• Ensure timely and accurate processing of grievances and appeals.

Skills

Medical claims experience

Communication skills

Problem solving

Independence

Confidentiality

Education

High School Diploma or GED

Tools

MS Office

Job description

Workday is seeking a Grievance & Appeal Specialist to address appeals within required timeframes and ensure contractual obligations are met. The role centers on accurate claims handling and timely resolutions in a fast-paced healthcare environment.

You will maintain, revise, and implement Policies and Procedures to ensure compliance with regulatory standards. This remote position requires strong communication, confidentiality, and the ability to work independently within a national telecommute