A company is looking for a Grievance & Appeals Specialist II to support TRICARE Prime Demo by enhancing healthcare access for the military community.
Key Responsibilities
Review and validate appeals submitted by providers and prepare them for clinical review
Document outcomes of appeals and maintain tracking spreadsheets for review results
Process various types of appeals and ensure resolution within regulatory timeframes
Required Qualifications
High school diploma or equivalent is required
Minimum of two years of healthcare customer service, claims, compliance, or related experience is required
Associates Degree or equivalent years of relevant work experience preferred
Military affiliation or TRICARE experience is preferred
Specialist • Corpus Christi, Texas, United States