Grievance Appeals Coordinator I

Are you a healthcare administrative professional looking for a meaningful, 100% remote opportunity? We are seeking dedicated problem solvers to join our growing team. Following a recent membership expansion that doubled our population in a key market, our workload has significantly increased, and we are adding team members to help support our Medicaid lines of business.

This role offers a collaborative, fast-paced, and fluid remote work environment where you will partner closely with clinical staff, medical directors, and case managers to triage, investigate, and resolve critical cases. Save time and money by avoiding the daily commute and working entirely from your own home office.

• Minimum of 2–3 years of experience in healthcare grievances and appeals work required.

• Experience working with Medicaid plans is highly preferred.

• Technical capability to navigate and troubleshoot across multiple database systems.

• Exceptional verbal and written customer service communication skills.

• Most recent professional experience must be within a related healthcare field. ***Candidates must be located in MST OR PST timezone for consideration***

salary: $20.99 - $21 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School

Responsibilities

In this role, you will manage the end-to-end lifecycle of member appeals and grievances. Your daily tasks include:

• Intake & Triage: Efficiently receive and categorize incoming appeals and grievances, ensuring all cases are logged accurately into internal systems.
• Investigation & Research: Conduct thorough research into member issues by reviewing medical records, provider notes, and historical data across multiple platforms.
• Stakeholder Communication: Act as a primary point of contact for members, providers, and regulators. This includes conducting telephonic outreach and drafting formal written notifications.
• Cross-Functional Collaboration: Partner closely with Medical Directors, Case Managers, and clinical staff to ensure complex cases receive the necessary medical and administrative oversight.
• Regulatory Compliance: Ensure every case meets stringent state and federal "turnaround time" (TAT) requirements for both verbal and written responses.
• Documentation: Maintain meticulous records within specialized applications (Trucare, Prime, Omni) and standard Microsoft 365 tools.

Skills

• communication
• customer service
• Multitasking
• Grievance and Appeals (2 years of experience is required)
• Medicare/Medicaid (2 years of experience is required)
• Written Communication
• Research

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.