Job Title
Grievance & Appeals Coordinator
Location
Remote (Work From Home)
Schedule
Monday–Friday | Standard Business Hours
Type
Full-Time Ongoing Contract (W2 Only)
Pay Range: $32–$34/hour
Summary
The Grievance & Appeals Coordinator is responsible for processing appeals, grievances, complaints, and inquiries received from members, authorized representatives, and regulatory agencies. This role focuses on analyzing customer concerns, conducting in-depth research, coordinating managerial-level conferences, and delivering accurate, compliant resolutions. The coordinator ensures all cases are documented thoroughly and resolved within corporate, regulatory, and accreditation standards.
Key Responsibilities
- Process appeals, grievances, complaints, and inquiries in accordance with corporate policies and regulatory requirements.
- Analyze customer concerns by reviewing facts, contextual information, and applicable policies to reach accurate determinations.
- Conduct research using internal systems, external resources, and cross-functional contacts to support case decisions.
- Coordinate, facilitate, and conduct managerial-level conferences with members and authorized representatives.
- Maintain detailed and accurate documentation outlining investigative steps and resolution actions.
- Prepare clear, compliant written correspondence communicating outcomes and resolutions using simple, member-friendly language.
- Ensure all cases meet required timeframes, accuracy standards, and response guidelines.
- Stay current on products, provider networks, internal policies, procedures, and applicable regulations.
- Protect the confidentiality of member, employee, corporate, and performance information at all times.
Required Qualifications
- Strong analytical mindset with the ability to examine facts, context, and policies to make informed decisions.
- Excellent written and verbal communication skills, including proficiency in proofreading, grammar, punctuation, spelling, and basic math.
- Ability to analyze, interpret, apply logic, conduct research, and produce clear, thorough written responses.
- Ability to apply policies and procedures to arrive at accurate conclusions.
- Ability to work in a fast-paced environment with tight deadlines and high-quality standards.
- Strong problem-solving skills and attention to detail.
- Ability to prioritize responsibilities and manage time effectively.
- Ability to work collaboratively with management and as part of a team to meet performance targets.
- Previous customer service or concierge experience (not strictly call-center/CSR focused).
- Strong PC and system skills with the ability to navigate multiple systems and databases.
Preferred Qualifications
- Background in writing and/or research.
Education
- Field of study in English/writing, Health Care Administration, history, Juris Doctorate, or a related discipline preferred.
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