Grievance Appeals Coordinator I

We are seeking a Grievance and Appeals Coordinator to join our 100% remote team. You will enjoy a highly productive, collaborative, and psychologically safe work environment where your expertise directly impacts member care. Save time and money by ditching the commute and working from your own home office.   Responsibilities Acknowledge, process, and resolve time-sensitive member appeals via fax, phone, or email within established regulatory turnaround times. Ensure full regulatory compliance in accordance with CMS, state guidelines, and NCQA quality standards. Coordinate across multiple departments to resolve complex issues impacting member care and health plan operations. Meet daily productivity benchmarks of 8-10 cases per day while maintaining or exceeding a 98% compliance rate for all appeal files. Skills Grievance & Appeals or UM Prior Authorization (1+ years required) Regulatory Knowledge (CMS, Medicaid, NCQA) Formal written communication and data entry accuracy Strict prioritization and time management Independent critical thinking and problem-solving Technology proficiency

salary: $22.49 - $22.5 per hour
shift: First
work hours: 8 AM - 5 AM
education: High School

Responsibilities

Acknowledge, process, and resolve time-sensitive member appeals via fax, phone, or email within established regulatory turnaround times.
Ensure full regulatory compliance in accordance with CMS, state guidelines, and NCQA quality standards.
Coordinate across multiple departments to resolve complex issues impacting member care and health plan operations.
Meet daily productivity benchmarks of 8-10 cases per day while maintaining or exceeding a 98% compliance rate for all appeal files.

Skills

• Formal written communication
• Prioritization and time manage
• Regulatory knowledge

Qualifications

• Years of experience: 1 year
• 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.