GRIEVANCE AND APPEALS COORDINATOR I

Are you an analytical problem solver with sharp attention to detail looking for a work-from-home opportunity? We are seeking a dedicated Grievance and Appeals Intake Coordinator to join our collaborative operations team! Save time and money by ditching the daily commute and working comfortably from your own home office.

In this key role, you will serve as the initial point of contact for executive complaints, member grievances, and provider appeals. Working Monday through Friday, 8:00 AM to 5:00 PM CST (with flexible start times within one hour and no weekend work), you will screen incoming submissions in the PRIME platform, review documentation completeness, and determine proper classifications across standard and expedited queues. You will partner with a supportive team to route cases to specialized liaisons and learn hands‑on workflows for resolving basic complaint files. If you bring strong organizational abilities, sharp accuracy, and a passion for healthcare operations, this position offers an ideal environment to apply your talents.

Salary: $22.99 - $23 per hour

Shift: First

Work hours: 8 AM - 5 PM

Education: High School

Responsibilities

Position Summary: Screen incoming member and provider appeals and grievances, classify case priorities in PRIME, and route documentation to assigned teams.

Key Responsibilities

• Screen all incoming correspondence and intake records within the PRIME system.
• Classify cases accurately as ERU, Informal Reg, or Expedited based on established criteria.
• Verify documentation completeness and route files to appropriate workbaskets and liaisons.
• Review and process basic complaint cases to support timely dispute resolutions.
• Maintain accurate electronic case records compliant with regulatory guidelines.

Requirements

• High School Diploma or equivalent required.
• strong analytical, accuracy, and organizational skills.
• Demonstrated computer literacy with experience navigating web-based databases.
• Prior experience in healthcare operations, claims, or grievances is a plus.
• Dedicated home workspace with ability to work standard CST business hours.

Skills

• Multi-tasking
• Answering Phones
• Organization

Qualifications

• Years of experience: 2 years
• Experience level: Experienced

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact View email address on apply.j-vers.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.