Appeals Reviewer

Working remotely on a contract basis, the Appeals Reviewer will analyze and research medical grievances and appeals for final resolution while maintaining knowledge of multiple systems and ensuring compliance with relevant standards. Key responsibilities Perform analysis and research of medical grievance and appeal requests, ensuring compliance with State, Federal, and URAC standards Review medical records to determine if they meet the required supporting information for appeals Monitor appeals and grievances, identifying trends or patterns and reporting findings to management Required qualifications High School Diploma or equivalent required 1+ year of claims processing, appeals review, or grievances review experience required Experience operating computer software without supervision is essential Knowledge of contract benefits is preferred