Senior Appeals & Grievances Leader

Jobgether; États-Unis; Sur place; USD 75 000 - 110 000; Plein temps

Avantages offerts par ce poste

Competitive compensation package

Comprehensive benefits package

Equal opportunity employer

Résumé du poste

Jobgether is seeking a Lead Specialist, Appeals & Grievances to oversee complex healthcare claims appeals, grievances, and complaints. You will act as a resource for colleagues, guiding challenging cases and distributing workloads across claims operations.

The role requires experience with Medicare/Medicaid and strong analytical, communication, and leadership skills to ensure accurate, timely, and compliant resolutions.

Qualifications

• At least 3 years of managed care experience in appeals or claims.
• Experience with Medicare/Medicaid denials and appeals.
• Strong written and verbal communication; professional tone.
• Ability to train and guide colleagues.

Responsabilités

• Lead the submission, intervention, investigation, and resolution of appeals, grievances, and complaints.
• Train new employees and guide colleagues handling complex issues.
• Investigate escalated matters incl. state complaints and high‑profile cases.
• Coordinate with claims leadership to assign work and manage workload.

Connaissances

Customer service

Analytical skills

Communication

Leadership

Organization

Time management

Claims processing knowledge

Regulatory compliance understanding

Formation

Healthcare-related vocational program

Outils

Microsoft Office

Description du poste

Jobgether is seeking a Lead Specialist, Appeals & Grievances to oversee complex healthcare claims appeals, grievances, and complaints. You will act as a resource for colleagues, guiding challenging cases and distributing workloads across claims operations.

The role requires experience with Medicare/Medicaid and strong analytical, communication, and leadership skills to ensure accurate, timely, and compliant resolutions.