Member Appeals Specialist (Remote) in Boston, Massachusetts - #72528 | VanderHouwen

Description

Job Id: 72528

Member Appeals Specialist (Remote)
Our client is seeking a detail-oriented and collaborative Member Appeals Specialist to manage member appeal cases in a fully remote environment. This individual will play a critical role in ensuring appeals are processed accurately, timely, and in compliance with established regulatory requirements. The ideal candidate is highly organized, responsive, eager to learn, and comfortable working independently while partnering closely with cross-functional teams in a virtual setting.

This role is fully remote.

Member Appeals Specialist Responsibilities

• Manage member appeal cases from intake through resolution, ensuring all required steps are completed within established timelines.
• Review appeal requests, verify eligibility and timeliness requirements, and determine necessary supporting documentation.
• Prepare and distribute appeal-related correspondence, acknowledgements, and determination notices using approved templates and reference materials.
• Communicate with members, representatives, and internal stakeholders to gather information, clarify case details, and support case progression.
• Maintain an active caseload while accurately documenting activities and utilizing multiple systems to ensure compliance and case integrity.

Member Appeals Specialist Qualifications

• Experience managing member appeals within a healthcare, insurance, pharmacy, or regulated benefits environment.
• Ability to independently manage a high-volume caseload while meeting strict deadlines and quality standards.
• Strong attention to detail with the ability to interpret policies, procedures, and reference materials accurately.
• Excellent written and verbal communication skills, including professional email etiquette and customer-focused interactions.
• Demonstrated success working in a remote, team-oriented environment with a willingness to learn, collaborate, and seek guidance when needed.

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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