Claims Appeals Specialist

Company: VirtualVocations
Location: Vista
Posted on: May 13, 2025

Job Description:

A company is looking for a Claims Appeals Specialist.
Key Responsibilities

Investigate and resolve member and provider complaints, appeals, disputes, and grievances
Utilize internal systems to research claims and determine outcomes in compliance with regulations
Draft appeal summaries and communicate decisions to members and providers

Required Qualifications

High School Diploma or GED required
Minimum 2 years of operational experience in managed care
Knowledge of Medicaid and Medicare regulatory guidelines
Experience with health claims processing

Keywords: VirtualVocations, Yorba Linda , Claims Appeals Specialist, Other , Vista, California

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