Grievance Appeals Coordinator I

Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. Education/Experience: High school diploma or equivalent. Associate’s degree preferred. 2+ years grievance or appeals, claims or related managed care experience. oral, written, and problem solving skills. • Gather, analyze and report verbal and written member and provider complaints, grievances and appeals • Prepare response letters for member and provider complaints, grievances and appeals • Maintain files on individual appeals and grievances • May coordinate the Grievance and Appeals Committee • Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information • Assist with HEDIS production functions including data entry, calls to provider’s offices, and claims research. • Manage large volumes of documents including copying, faxing and scanning incoming mail Candidates for this role will be joining a tight-knit team of Clinical Coordinators (licensed nurses) and Appeals & Grievances Coordinators (non-clinical professionals), the team works closely with Medical Directors, Case Managers, and Claims experts, creating a rich environment for learning and cross-functional engagement. They’ll be reviewing member appeals, grievances, and provider disputes. The work is deeply impactful, as it directly affects the lives of Medicaid members. They will gain hands-on experience with state contracts, NCQA guidelines, and internal systems that are foundational to healthcare operations. Our motto, “The only thing consistent in HealthCare is Change” is more than a saying. It’s a mindset. We embrace change with resilience and readiness, supporting each other through shifting regulations, evolving member needs, and new business lines like DSNP-Medicare and Marketplace. Must have: oral, written, and problem-solving skills. Nice to haves: 2+ years grievance  Skills Meeting deadlines in a fast-paced, compliance-driven environment Familiarity with Medicaid, DSNP-Medicare, and/or Marketplace Skilled use of Microsoft Office platforms (Word, Excel, Teams, Outlook, SharePoint)

salary: $22.85 - $22.86 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School

Responsibilities

• Gather, analyze and report verbal and written member and provider complaints, grievances and appeals
• Prepare response letters for member and provider complaints, grievances and appeals
• Maintain files on individual appeals and grievances
• May coordinate the Grievance and Appeals Committee
• Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information
• Assist with HEDIS production functions including data entry, calls to provider’s offices, and claims research.
• Manage large volumes of documents including copying, faxing and scanning incoming mail

Skills

• verbal and written
• grievances and appeals
• provider complaints

Qualifications

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

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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.