Grievance Appeals Specialist

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