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Appeals & Grievance Specialist

Della InfotechIrving, TX🇺🇸United StatesPosted 21 Jul 2026

Why This Role Stands Out

This Appeals & Grievance Specialist role at Della Infotech offers a fantastic opportunity to leverage your expertise in managed care and customer service within a dynamic hybrid environment. You'll thrive here if you possess strong problem-solving skills and a dedication to ensuring member satisfaction, with excellent potential for professional development. Apply now to join a reputable company and make a meaningful impact.

Quick Overview

Work Type
Hybrid
Level
Mid Senior

Job Description

Required Qualifications:
High School Diploma (proof of education required at the time of submission)
Minimum 3 years of customer service experience with Managed Care Plans
Minimum 2 years of Appeals & Grievance experience with Managed Care Plans
Strong knowledge of claims processing, benefit interpretation, CPT & ICD coding
Experience handling member and provider appeals, grievances, claim denials, and complaint resolution
Key Responsibilities:
Research and resolve member and provider appeals, grievances, claim denials, and complaints.
Review benefit determinations and claims while ensuring compliance with CMS, TRICARE, and organizational guidelines.
Coordinate with internal departments to facilitate timely and accurate resolutions.
Analyze appeals and grievance trends, prepare reports, identify root causes, and recommend process improvements.

Skills

Complaint Resolution
Compliance

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