Appeals and Grievance Specialist

Position Type
Full-Time/Regular

**It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.**

**Job Summary:**

**The Appeals and Grievance Specialist is responsible for managing the resolution process of medical and pharmacy member appeals and/or member generated complaints/grievances, and ensuring compliance with contractual obligations, regulatory requirements and accreditation standards.**

**Our Investment in You:**

· **Full-time remote work**

· **Competitive salaries**

· **Excellent benefits**

**Key Functions/Responsibilities:**

**Appeals Responsibilities:**

· **Executes member appeals across multiple departments within the Plan and with representatives from external vendors**

· **Determines and...