Member Appeals Specialist (Remote) in Boston, Massachusetts - #72858 | VanderHouwen

Description

Job Id: 72858

Member Appeals Specialist (Remote)
Our client is seeking a Member Appeals Specialist (Remote) to join a collaborative team supporting member-focused appeals in a highly regulated healthcare environment. The ideal candidate is organized, detail-oriented, and committed to delivering accurate, timely work while managing multiple priorities. This role is well suited for someone who thrives in a fully remote setting, communicates effectively, and enjoys working cross-functionally to ensure quality outcomes and an exceptional member experience.

This role is 100% remote.

Member Appeals Specialist Responsibilities

• Manage member appeal cases from intake through resolution, ensuring accuracy, compliance, and timely completion.
• Review, prioritize, and coordinate incoming appeals, including gathering required documentation and communicating with members as needed.
• Prepare and maintain case documentation, correspondence, and decision notices using established templates and regulatory guidelines.
• Collaborate with cross-functional teams to support case progression, resolve questions, and ensure consistent case handling.
• Utilize multiple healthcare systems and communication tools to manage an active caseload while meeting established service-level expectations.

Member Appeals Specialist Qualifications

• Experience managing member appeals within a health insurance or managed care environment, including ownership of cases from intake through resolution.
• Experience managing member appeals in a healthcare or health insurance environment from intake through resolution.
• Ability to effectively prioritize and manage a high-volume caseload while consistently meeting regulatory deadlines.
• Strong attention to detail with experience preparing professional correspondence and maintaining accurate case documentation.
• Excellent written and verbal communication skills, including professional email etiquette and the ability to work effectively in a fully remote environment.
• Proficiency navigating multiple systems and willingness to learn new processes, reference materials, and case management platforms.

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.

#LI-Remote