Member Appeals Specialist (Remote) in Boston, Massachusetts - #70066 | VanderHouwen

Description

Job Id: 70066

Member Appeals Specialist (Remote)
Our client seeks a detail-oriented, proactive professional who thrives in a collaborative, virtual environment. The ideal candidate excels at time-sensitive work, is comfortable navigating complex systems, and communicates effectively with both team members and external stakeholders. If you’re dependable, inquisitive, and ready to contribute to a supportive and mission-driven team, we’d love to hear from you!

This is a remote role. Candidates must be located in the following states: AL, AZ, CO, CT, FL, GA, ID, IL, IN, KS, KY, ME, MD, MA, MI, MN, MO, NV, NH, NJ, NM, NY, NC, OH, OK, OR, PA, RI, SC, TN, TX, UT, VT, VA, WA, WV, or WI.

Member Appeals Specialist Responsibilities

• Triage and assign incoming appeals and grievances, ensuring proper categorization.
• Manage 40+ active member pharmacy appeals with regulatory timeliness.
• Draft and issue compliant acknowledgement and decision notices using templates.
• Conduct verbal outreach for documentation and coordinate with cross-functional teams.
• Utilize multiple systems for case tracking and communication.

Member Appeals Specialist Qualifications

• Experience with member appeals, particularly pre-service pharmacy (non-Medicare).
• Skilled in managing caseloads within appeals systems like Jiva.
• Strong written communication and professional email etiquette.
• Reliable, detail-focused, and engaged in virtual work environments.
• Willingness to learn and apply reference materials to ensure compliance.

Compensation: 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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