Member Appeals Specialist (Remote) in Boston, Massachusetts - #71592 | VanderHouwen

Description

Job Id: 71592

Member Appeals Specialist (Remote)
Our client is seeking a detail-driven Member Appeals Specialist who thrives in a structured, compliance-focused environment and communicates with clarity and empathy. The ideal candidate is highly organized, responsive, and comfortable managing multiple cases while collaborating across a fully virtual team. Success in this role requires sound judgment, strong written communication, and a proactive approach to follow-through.

This role is fully remote.

Member Appeals Specialist Responsibilities

• Triage and categorize incoming member appeals and grievances, ensuring accurate routing and timely handling.
• Manage appeals from intake through resolution, including eligibility and timeliness evaluation.
• Prepare and issue required correspondence using standardized templates, with case-specific adjustments.
• Conduct outbound outreach to gather documentation, clarify details, and resolve information gaps.
• Maintain an active caseload while adhering to regulatory turnaround times and workflow requirements.

Member Appeals Specialist Qualifications

• Prior experience handling member appeals, preferably within pre-service or pharmacy coverage contexts.
• Demonstrated ability to manage caseloads within a system of record and follow defined workflows.
• Strong written and verbal communication skills, with professional email etiquette.
• High attention to detail, reliability, and commitment to accuracy in compliance-driven work.
• Comfort working in a fully remote, team-oriented environment using multiple business systems.

Compensation: $20-$22/hr. (DOE)

VanderHouwen Contractors Enjoy Exceptional Benefit Perks!
As an eligible contract employee with VanderHouwen, you’ll have access to a full suite of benefits designed with your well-being in mind. Our comprehensive package includes medical, dental, vision, life insurance, short- and long-term disability, and a matching 401(k) to help secure your future.

Meet VanderHouwen
What kind of recruiter do you see yourself working with? One who prioritizes your best interest, no matter what? VanderHouwen does, and we’re in it for the long game! Our recruiters focus on YOU, building meaningful, long-term relationships while developing a deep understanding of companies’ staffing needs and workplace cultures. This approach helps us find an ideal job match that aligns with your unique career aspirations and goals.

VanderHouwen is an award-winning, Women & Diversity-Owned, WBENC certified professional staffing firm. Founded in 1987, VanderHouwen places experienced professionals across the nation! Our recruitment teams specialize in either Technology and IT, Engineering, Human Resources, or Accounting and Finance career markets. Partner with us to land your next exciting career!

VanderHouwen is an Equal Opportunity Employer and participates in E-Verify. VanderHouwen does not discriminate based on race, color, religion, sex, national origin, age, disability, or any other characteristic protected by applicable local, state, or federal civil rights laws.

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