VirtualVocations
via Talent.com
Medicare Appeals Operations Expert
Compensation
$0K - 0K a year
Responsibilities
Manage appeals and grievances operations, analyze data for trends, and support compliance efforts.
Requirements
Requires a bachelor's degree or equivalent experience, 5+ years in Medicare Advantage, and expert knowledge of CMS regulations and appeals processes.
Full Description
A company is looking for an Appeals and Grievances Operations Expert. Key Responsibilities Oversee production, accuracy, and timely delivery of appeals and grievances operational and regulatory reports Analyze appeals data to identify trends, operational bottlenecks, and training needs Support internal compliance requests by providing data / reports and subject matter expertise Required Qualifications Bachelor's degree in healthcare administration, nursing, business, or related field, or equivalent work experience 5+ years of experience in Medicare Advantage plans, with at least 3 years in appeals and grievances In-depth knowledge of CMS regulations and Medicare Managed Care Manual Expert-level understanding of Medicare Advantage appeals and grievance requirements Proficiency with Microsoft Excel, PowerPoint, and appeals / case management systems
This job posting was last updated on 1/9/2026
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