Grievance and Appeals Specialist

We are currently seeking experienced Appeals & Grievances Specialists!  This is a full remote opportunity paying $27/hr.  The ideal candidate has experience investigating and responding in writing to internal and regulatory complaints.  Experience in ACA is a plus.  If you are interested, please apply and we will be in touch!

salary: $26.99 - $27 per hour
shift: First
work hours: 8 AM - 4 PM
education: No Degree Required

Responsibilities

• Investigate regulatory complaints, appeals, grievances, BBB inquiries, executive escalations, CMS or HICS matters, state DOI matters, and other high-sensitivity cases.
• Collect and analyze case records, call notes, emails, claims information, billing history, eligibility records, plan documents, provider information, and internal findings.
• Draft clear, factual, neutral, and compliant response summaries for leadership review, agency submission, or customer communication.
• Track regulatory deadlines, required documentation, extensions, case status, owner assignments, and follow-up commitments.
• Partner with Compliance, Legal, Billing, Finance, Claims, Enrollment, Network, Clinical Operations, Product, Tier 1, and Tier 2 to obtain accurate information.
• Maintain complaint logs, case files, investigation notes, and supporting documentation in a complete and audit-ready manner.
• Identify root cause themes and recommend corrective actions that reduce repeat complaints and regulatory exposure.

Skills

• Appeals and Grievances (2 years of experience is required)
• ACA (1 year of experience is preferred)

Qualifications

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

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.

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 randstadusa.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.