Job Title: Grievance and Appeals Coordinator
Location: Remote in the US
Job Type: Long-term open ended W2 Contract
Expected hours per week: 40 hours per week
Pay: $31 per hour
Grievance & Appeals (G&A) Coordinator
The Grievance & Appeals (G&A) Coordinator is responsible for reviewing, researching, and resolving appeals, grievances, complaints, and inquiries submitted by members, authorized representatives, and regulatory agencies. This role requires strong analytical, research, and writing skills to ensure accurate, timely, and compliant case resolutions.
The Coordinator evaluates customer concerns, conducts thorough research using internal systems, policies, contracts, and external resources, and makes sound case determinations. This role also facilitates and participates in managerial-level conferences with members and authorized representatives to gather and communicate relevant information.
Accurate documentation is critical. The Coordinator maintains detailed case records outlining investigative steps, actions taken, and final outcomes. All resolutions are communicated through clear, concise written correspondence that meets corporate, regulatory, and accreditation standards for accuracy, quality, and timeliness.
The Coordinator is expected to stay current on products, provider networks, internal policies, procedures, and applicable state and federal regulations to support accurate decision-making.
Top 3 Required Skills & Experience
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Strong analytical skills – Ability to assess complex issues, analyze facts and context, and make informed, well-reasoned decisions
- Excellent written and verbal communication – High proficiency in grammar, spelling, proofreading, and clear written explanations
- Research and critical thinking – Ability to interpret policies, contracts, and regulations and construct thorough, well-supported responses
Required Skills & Experience
- Ability to apply policies and procedures to reach accurate conclusions
- Strong problem-solving abilities with high attention to detail
- Ability to work effectively in a fast-paced, deadline-driven environment
- Excellent time management and prioritization skills
- Ability to collaborate effectively with management and cross-functional teams
- High regard for confidentiality of member, employee, corporate, and performance information
- Prior customer-facing experience (customer service, concierge, or similar; not limited to CSR roles)
- Strong computer skills with the ability to navigate multiple systems and databases
- Proficiency with Microsoft Office Suite
Preferred Skills & Experience
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Background in research, writing, legal, compliance, or administrative roles
- Experience with claims processing or healthcare systems (e.g., NASCO, Facets)
- Experience interpreting contracts, claims, or regulatory guidance
- Exposure to regulatory agencies (e.g., CMS, Department of Labor)
- Paralegal, legal analyst, or claims analyst experience
Education
- Bachelor’s degree required
- Preferred fields of study include:
- English or Writing
- Health Care Administration
- History
- Legal Studies / Paralegal Studies
- Juris Doctor (JD) or related discipline
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