Offer summary

Qualifications:

Associate degree in a related field (Bachelor’s preferred), 3+ years of relevant professional experience in healthcare, managed care, or compliance, Strong communication and writing skills, Proficiency in Microsoft Office, especially Word and Excel..

Key responsibilities:

Review and classify member and provider grievance and appeal requests

Investigate thoroughly using internal and external resources

Prepare detailed case summaries for medical and administrative review

Track and monitor cases to ensure timely resolution within regulatory deadlines.

Job description

Job Title: Grievance & Appeals Specialist
Location: Remote (Must be in CST or EST)
Job Type: Temporary
Pay: $23.50 per hour

About the Role:

We are seeking a detail-oriented Grievance & Appeals Specialist to join our team on a temporary, remote basis. In this role, you’ll manage member and provider complaints, appeals, and grievances, ensuring compliance with NCQA, CMS, and state regulations. Your work will help maintain strong relationships and accurate benefit determinations while supporting regulatory standards and internal quality.

Key Responsibilities:

Review and classify member and provider grievance and appeal requests
Determine benefits, eligibility, and prior activity related to the issue
Send written acknowledgments and conduct outreach calls to clarify complaints
Investigate thoroughly using internal and external resources
Collaborate with internal departments and external entities for case resolution
Prepare detailed case summaries for medical and administrative review
Track and monitor cases to ensure timely resolution within regulatory deadlines
Write clear, accurate responses that fully address the issue
Maintain documentation and reporting per internal standards
Identify process improvement opportunities and share recommendations
Perform additional tasks as needed

Qualifications:

Associate degree in a related field (Bachelor’s preferred)
3+ years of relevant professional experience
Experience in healthcare, managed care, or compliance required
Strong communication and writing skills
Proven ability to manage sensitive information with accuracy and professionalism
Proficiency in Microsoft Office (especially Word and Excel)
Strong analytical and organizational skills

Benefits through CGC: Payday Fridays, Dental, Vision, STD and/or LTD, Voluntary Life & AD&D, Accident, Critical Illness, Hospital Indemnity, Health Advocate EAP, and Health Equity Commuter Benefits, ZayZoon, and 401k.

We are an equal opportunity employer and prohibit discrimination/harassment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws

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