Appeals & Grievances Specialist

Job Description

An employer is looking for a remote Appeals & Grievances Specialist who will be responsible for managing and resolving appeals and grievances related to dental insurance claims. This role requires strong analytical and communication skills, attention to detail, and the ability to work independently in a remote environment while collaborating with internal teams and external stakeholders.

Key Responsibilities

• Review, research, and process appeals and grievances in compliance with company policies and regulatory requirements.

• Draft clear, professional written responses and documentation for appeals and grievances.

• Utilize Microsoft Word, Excel, Adobe, and Outlook for reporting, documentation, and communication. Apply critical thinking to analyze complex cases and identify appropriate resolutions.

• Communicate effectively with members, providers, and internal departments to gather necessary information.

• Maintain accurate records and ensure timely follow-up on all cases.

• Set up and manage remote workstation; troubleshoot and engage with IT support as needed.

• Perform outbound calls to providers and members regarding claims.

• Leverage patient/member services experience to ensure empathetic and effective communication.

Skills and Requirements

• High School Diploma or GED required.

• 2+ years of experience dental insurance, or dental-related roles.

• Strong writing and communication skills. Proficiency in Microsoft Word, Excel, Adobe, and Outlook. Ability to understand and use dental terminology.

• Demonstrated research and problem-solving capabilities.

• Ability to work independently and manage multiple priorities in a remote setting.

• Understands state and federal requirements

• Have worked in a dental office for at least 6 months over career

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to [email protected].