Grievance & Appeals Coordinator I

BCforward is currently seeking a highly motivated Grievance & Appeals Coordinator I for an opportunity Remote!

Position Title: Grievance & Appeals Coordinator I

Location: Remote CST

Expected Duration: 06 Months

Job Type: [FULL TIME (>%3D40 HRS WEEKLY], [CONTRACT], [Remote]

Monday - Friday, 8:00 AM - 5:00 PM

Targeted Start date: May 12, 2025

Pay Rate: $25-$27 per hour

Position Summary:

The Grievance & Appeals Coordinator I is responsible for analyzing and resolving verbal and written claims and authorization appeals from providers and members, as well as managing the intake and resolution process for formal grievances. This position plays a key role in ensuring timely and accurate responses to complaints and supports key business processes including performance tracking and regulatory compliance for the Ambetter A&G Department.

Key Responsibilities:

• Gather, analyze, and report on member and provider complaints, grievances, and appeals.
• Prepare response letters and maintain documentation for appeals and grievance cases.
• Coordinate intake and case creation for incoming grievances and appeals from multiple sources.
• Support and potentially coordinate the Grievance and Appeals Committee.
• Manage administrative tasks including scanning, copying, faxing, and handling incoming mail.
• Support pay-for-performance programs with data entry, tracking, and research.
• Assist with HEDIS production activities (e.g., provider outreach, claims research, data entry).
• Participate in team chats and communications to ensure efficient workflow and case management.

Required Qualifications:

• Education: High School Diploma or equivalent required; Associate degree preferred.
• Experience: Minimum of 2 years in grievances, appeals, claims, or managed care roles.
• Healthcare knowledge: 1-2 years in healthcare/customer service with direct experience in grievance and appeals processes.
• Strong organizational skills and ability to manage high volumes of documentation.
• Excellent written and verbal communication skills.
• Proficient in problem-solving and collaboration across teams.

Preferred Qualifications:

• Bachelor's degree in healthcare administration or related field.
• Prior experience in a healthcare or insurance administrative role.
• Strong attention to detail and the ability to multitask.
• Familiarity with HEDIS and pay-for-performance programs.

Top Skills Required (Stack-Ranked):

Benefits
BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.

About BCforward:
Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.

Interested candidates please send resume in Word format Please reference job code 237670 when responding to this ad.