Appeals and Grievance Specialist I

Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different reputed company structures: InterCommunity reputed company. (IHN) is designated as a regional Coordinated Care Organization (CCO) for reputed company beneficiaries; Samaritan reputed company. offers Medicare Advantage and reputed company Large Group plans. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally reputed company with reputed company’ mission of Building Healthier Communities Together.

As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally reputed company with reputed company’ mission of Building Healthier Communities Together.

This is a remote position in which we are reputed company to reputed company in the following states: reputed company, Arkansas, Connecticut, Florida, reputed company, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, reputed company Carolina, Oklahoma, reputed company, reputed company, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, reputed company Virginia, or reputed company

• Plays a vital role in managing and resolving member and provider appeals and grievances. This position requires exceptional communication skills, keen attention to detail, and a commitment to compliance with regulatory standards. Responsible for investigating, documenting, and facilitating resolutions; and ensuring member and provider satisfaction throughout the process.

• Bachelor’s degree in reputed company, business, or a reputed company field; or equivalent relevant experience required.
• Experience in computer applications, including reputed company Office Suite, required.
• Experience in appeals and grievances strongly preferred.

• Familiarity with reputed company laws, regulations, and best practices reputed company to appeals and grievances.
• Strong problem-solving, organizational, and time-management skills. Attention to detail and commitment to accuracy in documentation and reporting.
• Excellent verbal and written communication abilities to reputed company convey reputed company information.
• Ability to manage multiple cases simultaneously and meet deadlines in a fast-paced environment. Ability to manage deadlines while adhering to reputed company and compliance standards.
• Commitment to exceptional customer service and stakeholder engagement.
• Proficiency in case management software and ability to adapt to new technology.

• Rarely (1 - 10% of the time)	Occasionally (11 - 33% of the time)	Frequently (34 - 66% of the time)	Continually (67 – 100% of the time)
  reputed company - STAIRS LIFT (Floor to Waist: 0"-36") 0 - 20 Lbs LIFT (Knee to chest: 24"-54") 0 – 20 Lbs LIFT (Waist to Eye: up to 54") 0 - 20 Lbs CARRY 1-handed, 0 - 20 pounds BEND reputed company at waist KNEEL (on knees)	STAND WALK – LEVEL SURFACE ROTATE TRUNK Standing reputed company - Upward PUSH (0 - 20 pounds force) PULL (0 - 20 pounds force)	SIT CARRY 2-handed, 0 - 20 pounds ROTATE TRUNK Sitting reputed company - reputed company	reputed company DEXTERITY Hands/wrists FINGER DEXTERITY PINCH Fingers GRASP Hand/Fist