Lead Specialist, Appeals & Grievances

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Lead Specialist, Appeals & Grievances based in the United States.

As a Lead Specialist, Appeals & Grievances, you will oversee complex healthcare claims appeals, grievances, and complaints, ensuring that members and providers receive accurate, timely, and compliant resolutions. You will serve as a key resource for colleagues, providing guidance on challenging cases and supporting the effective distribution of team workloads.

Working across claims operations and other business functions, you will investigate payment disputes, interpret coverage requirements, and identify the root causes of claims issues. Your expertise will help ensure adherence to Medicare, Medicaid, and other applicable regulatory standards.

Through detailed documentation, clear communication, and careful case analysis, you will contribute to improved service quality and operational consistency. This role is ideal for an experienced managed care professional with strong analytical skills, sound judgment, and a commitment to member and provider satisfaction.