Lead Specialist, Appeals & Grievances (Remote)

The Lead Specialist, Appeals & Grievances provides lead-level support for claims activities, including reviewing and resolving member and provider complaints while communicating resolutions in compliance with CMS standards. This role involves training new employees, researching complex cases, and ensuring timely responses according to state, federal, and company guidelines. The position requires strong organizational, communication, and customer service skills to manage appeals, grievances, and claims processing effectively.