Grievance and Appeals Specialist

Our client, a leading healthcare organization, is seeking a Grievance & Appeals Specialist I to join their team. As a Grievance & Appeals Specialist I, you will be part of the healthcare operations department supporting member and provider relations. The ideal candidate will have strong analytical skills, excellent communication abilities, and a detail-oriented mindset, which will align successfully in the organization.

Job Title: Grievance and Appeals Specialist

Location: Meridian, ID

Pay Range: $27 an hour

Shift: Monday-Friday | 8:00 AM-5:00 PM

What's the Job?

• Investigate, analyze, and manage member appeals and grievance cases to ensure timely resolution.

• Ensure cases are accurately classified, categorized, and documented in compliance with regulatory standards.

• Research complex issues and determine if additional information is needed to support decision-making processes.

• Prepare detailed case histories for committee reviews, audits, and regulatory compliance purposes.

• Interpret and apply business rules, policies, benefit plans, and contract language effectively.

What's Needed?

• Minimum of 3 years of experience in healthcare operations, claims, appeals, or customer service.

• Strong verbal and written communication skills to effectively interact with members and providers.

• Knowledge of medical terminology, ICD-10, and CPT coding systems.

• Experience interpreting individual and group contract language.

• Strong analytical, investigative, and problem-solving skills to handle complex cases.

• Claims processing experience preferred.

What's in it for me?

• Opportunity to work in a dynamic healthcare environment committed to making a positive impact.

• Engage in meaningful work that supports member and provider satisfaction.

• Collaborate with a dedicated team of professionals in a supportive setting.

• Gain valuable experience in healthcare compliance and regulatory standards.

• Be part of an organization that values diversity and inclusion.

Upon completion of waiting period, associates are eligible for:

• Medical and Prescription Drug Plans

• Dental Plan

• Supplemental Life Insurance

• Short Term Disability Insurance

• 401(k)

If this is a role that interests you and you'd like to learn more, click apply now and a recruiter will be in touch with you to discuss this great opportunity. We look forward to speaking with you!

About ManpowerGroup, Parent Company of: Manpower, Experis and Talent Solutions.

Manpower® is a global leader in contingent staffing and permanent resourcing, providing companies with strategic and operational flexibility and creating talent at scale. Our specialized recruiting teams assess and guide talent into meaningful, sustainable employment, while our PowerSuite technology enables deeper insight and smarter matching, helping candidates find opportunities that align with their strengths, experience, and career goals.

In this constantly shifting world, our flexible workforce solutions provide companies with the business agility needed to succeed. Manpower is part of the ManpowerGroup® (NYSE: MAN) family of brands, which also includes Experis and Talent Solutions. For more information about Manpower, follow us on LinkedIn, Facebook, X and Instagram.

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