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Job Description
Our Grievance & Appeals Specialist is responsible for reviewing and resolving member and provider grievances, complaints, appeals, and provider claim disputes across the Health Plan division, including Commercial and Medicare product lines. This role ensures all cases are handled accurately, timely, and in full compliance with contractual and regulatory requirements. This position serves as a key point of coordination between members, providers, and internal partners, working closely with Health Plan Operations, Network Solutions, Pharmacy, Utilization Management, Legal, and other teams to support thorough case review and resolution.