Member Appeals Specialist (Remote) in Boston, Massachusetts - #72225 | VanderHouwen

Description

Job Id: 72225

Member Appeals Specialist (Remote)
Our client is seeking a detail-oriented and highly organized Member Appeals Specialist who thrives in a structured, process-driven environment and can manage sensitive information with accuracy and professionalism. This individual will play a critical role in ensuring timely, compliant handling of member appeals while collaborating cross-functionally in a fully remote setting. The ideal candidate brings strong communication skills, accountability, and a proactive approach to managing a high-volume caseload.

This role is fully remote.

Member Appeals Specialist (Remote) Responsibilities

• Triage, categorize, and assign incoming member appeals and grievances while maintaining accuracy and timeliness.
• Manage end-to-end case processing, including eligibility review, documentation requirements, and adherence to regulatory turnaround times.
• Draft and issue acknowledgment letters and appeal determination notices using standardized templates and reference materials.
• Conduct outbound outreach to members, providers, or internal teams to gather necessary information and resolve case-related questions.
• Collaborate with cross-functional teams and utilize multiple systems to manage a caseload of approximately 40 active appeals.

Member Appeals Specialist (Remote) Qualifications

• 2+ years of experience handling member appeals, preferably within a healthcare or insurance environment.
• Demonstrated ability to manage a high-volume caseload within a structured case management system.
• Strong written and verbal communication skills, including professional email etiquette.
• High attention to detail with the ability to follow processes, interpret guidelines, and ensure compliance.
• Self-motivated and collaborative, with the ability to work effectively in a fully remote, team-oriented environment.

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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