Member Appeals Specialist (Remote) in Boston, Massachusetts - #71053 | VanderHouwen

Description

Job Id: 71053

Member Appeals Specialist (Remote)
Our client is seeking a detail-oriented and collaborative Member Appeals Specialist to support their Appeals & Grievances team. The ideal candidate thrives in a structured, compliance-driven environment, demonstrates excellent written and verbal communication, and enjoys balancing independent case management with teamwork in a virtual setting. This role suits someone who is both analytical and empathetic, ensuring members receive timely and accurate resolution of their appeals.

This role is fully remote.

Member Appeals Specialist (Remote) 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 acknowledgement and decision letters using system templates.
• Conduct verbal outreach to obtain missing information or documentation as needed.
• Manage a case load of appeals, maintaining compliance with regulatory turnaround times and documentation standards.

Member Appeals Specialist (Remote) 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 and attention to detail 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.

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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