• Handle end-to-end Medicare Appeals and Grievances processing.

• Process Medicare Part C and Part D appeals.

• Perform AOR (Appointment of Representative) validation and provider outreach.

• Review claim denial reasons and supporting clinical documentation.

• Prepare appeal cases for Medical Director review.

• Process appeal determinations and effectuation activities.

• Ensure compliance with CMS guidelines and turnaround requirements.

• Maintain accuracy and quality in claims administration.

Required Skills and Qualifications

• Any graduate with 1–3 years of relevant healthcare operations experience.

• Hands-on experience in Medicare Appeals and Grievances.

• Knowledge of Medicare Part C and Part D.

• Understanding of CMS regulations and turnaround timelines.

• Experience in AOR validation and provider outreach.

• Ability to review denial rationale and clinical documentation.

• Good analytical, communication, and documentation skills.