Member Appeals SpecialistVirtualVocations • Baton Rouge, Louisiana, United States
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Member Appeals Specialist
VirtualVocations • Baton Rouge, Louisiana, United States
[job_card.30_days_ago]
[job_preview.job_type]
- [job_card.full_time]
[job_card.job_description]
A company is looking for a Member Appeals Specialist (Remote).
Key Responsibilities
Triage and assign incoming member appeals and grievances; manage daily email and voicemail queues
Evaluate appeal eligibility, timeliness, and completeness of submitted documentation
Prepare and issue acknowledgment and decision letters using system templates
Required Qualifications
Prior experience managing member appeals (pharmacy or medical); knowledge of pre-service coverage preferred
Proficient in case management systems such as Jiva, and familiar with PBM tools (ESI), Facets, Outlook, and Teams
Strong organizational skills with proven reliability in remote work
Clear, professional communication and email etiquette; responsive and proactive follow-up
Team-oriented mindset with a commitment to learning, compliance, and quality improvement
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Member Specialist • Baton Rouge, Louisiana, United States
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