UST · 2 weeks ago
Appeals and Grievances Operations Expert
United States
Full-time
Remote
Mid, Senior Level
$65K/yr - $85K/yr
5+ years expUST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. They are seeking a highly motivated Appeals and Grievances Operations Expert to ensure compliance with CMS regulations while driving operational excellence in the Medicare Advantage appeals/grievance process.
ConsultingInformation ServicesInformation Technology
Responsibilities
Oversee production, accuracy, and timely delivery of appeals and grievances operational and regulatory reports
Partner with reporting teams to ensure metrics are clearly defined, consistently calculated, and reflect current operational realities
Analyze appeals data to identify trends, operational bottlenecks, and training needs
Present findings and recommendations to leadership to drive performance improvement
Support internal compliance requests by providing data/reports, documentation, and SME expertise
Qualification
Required
Bachelor's degree in healthcare administration, nursing, business, or related field, or equivalent work experience
5+ years' experience in Medicare Advantage plans (at least 3 years in appeals & grievances)
In-depth knowledge of CMS regulations and Medicare Managed Care Manual
Expert-level understanding of Medicare Advantage appeals and grievance requirements
Strong understanding of claims processes
Skilled at overseeing reporting deliverables and turning data into actionable insights
Strong data analysis and reporting oversight skills
Excellent written and verbal communication skills
Proficiency with Microsoft Excel, PowerPoint, and appeals/case management systems
Able to identify root causes and recommend effective solutions
Benefits
Accrue up to 16 days of paid vacation per year
Receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year)
10 paid holidays
Eligible for paid bereavement leave
Eligible to participate in the Company’s 401(k) Retirement Plan with employer matching
Eligible for medical, dental, and vision insurance
Company-paid benefits: basic life insurance, accidental death and disability insurance, and short- and long-term disability benefits
May purchase additional voluntary short-term disability benefits
Participate in a Health Savings Account (HSA)
Flexible Spending Account (FSA) for healthcare, dependent child care, and/or commuting expenses
Potential for quarterly incentive-based bonuses and or commissions depending on role
Company
UST
UST is a Digital Transformations Solutions Provider.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$250MKey Investors
Temasek Holdings
2018-06-27Private Equity· $250M
Leadership Team
Krishna Sudheendra
CEO
Alexander Varghese
Chief Administrative Officer & COO
Recent News
2026-01-20
2026-01-20
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