Appeals and Grievance Specialist

Appeals and Grievance Specialist responsible for managing member complaints, grievances, appeals, and certain regulatory inquiries to ensure timely, accurate, and compliant resolutions. You will determine whether cases are clinical or non-clinical and route them to the appropriate internal partners. Collaborate across Operations, Health Services, Legal, and Markets to drive continuous improvement and maintain regulatory compliance while delivering an exceptional experience for members and providers. Requires outstanding written and verbal communication, strong problem-solving and analytical abilities, and the ability to manage multiple priorities in a fast-paced environment. This is an office role requiring onsite presence an average of 3 days per week at Minnetonka, MN; Madison, WI; Omaha, NE; or St. Louis, MO. Proficiency with Microsoft Word, Excel, and Outlook is expected.