Grievance & Appeals Coordinator I

Grievance & Appeals Coordinator I

BC Forward is looking for Grievance & Appeals Coordinator I (Remote) in Arkansas.

Position Title: Grievance & Appeals Coordinator I (Remote)

Locations: Remote - AR (Arkansas)
Anticipated Start Date: 6/23
Expected Duration: 3 Months
Job Type: Contract with possible extension
Shift: 8:00-5:00 CST
Pay Rate $20.00/hr. on W2
Need: Minimum of 2 years of experience in grievances, appeals, claims processing, or a related role within managed care and Associates Degree.


Job Description:
Position Title: Grievance and Appeals Specialist
Position Purpose:
Responsible for analyzing and resolving verbal and written claims and authorization appeals submitted by providers, as well as managing and pursuing the resolution of formal member grievances. Ensures timely and accurate handling of cases in compliance with regulatory and organizational standards.
Key Responsibilities:

• Investigate and resolve verbal and written complaints, grievances, and appeals from members and providers.
  
• Draft clear, professional response letters to address grievances and appeals.
  
• Maintain detailed and organized case files for all appeals and grievances.
  
• Coordinate and support the Grievance and Appeals Committee as needed, including scheduling, documentation, and follow-up.
  
• Support pay-for-performance programs through accurate data entry, tracking, organization, and research.
  
• Assist with HEDIS production activities, including data entry, outreach to provider offices, and claims research.
  
• Handle high volumes of documentation, including copying, faxing, scanning, and managing incoming mail.
  

Education and Experience Requirements:

• High school diploma or equivalent required; Associate's degree preferred.
  
• Minimum of 2 years of experience in grievances, appeals, claims processing, or a related role within managed care.
  
• Strong written and verbal communication skills.
  
• Excellent analytical and problem-solving abilities.
  
• Proficiency in managing administrative tasks and working with large volumes of documentation.
  

Day-to-Day Responsibilities:
In this role, you'll be responsible for managing the appeals process for denied medical claims submitted by providers and members. A typical day includes:

• Reviewing incoming faxes related to appeals of denied medical claims from providers and members.
  
• Assessing appeal validity and routing appropriate documentation to an external vendor for clinical review.
  
• Processing outcomes from the vendor by adhering to internal protocols-this includes preparing and sending notification letters to providers and/or members regarding appeal decisions.
  
• Occasional outreach via phone calls to communicate outcomes when necessary.
  
• Maintaining accurate documentation and ensuring timely follow-up in accordance with regulatory requirements.
  

---

Required Skills/Experience:

Proficiency in computer skills

Strong oral and written communication skills

Effective problem-solving abilities

Experience with health claims processing

Preferred Skills/Experience:

Advanced computer proficiency

Excellent interpersonal and analytical skills

In-depth knowledge of medical claims procedures

Education Requirement:
High School Diploma
Preferred Education:
Associate's degree or 2+ years of experience with the medical claims process


Project Description (Outside of Workday JD):
You will be part of a process that ensures fair and thorough evaluation of denied medical claims. By coordinating with external vendors and internal departments, the goal is to support proper resolution and communication for all appeal cases. The role requires a high level of attention to detail, confidentiality, and adherence to compliance standards.

---

Performance Expectations & Metrics:

• Complete at least 2 appeal cases per day with accuracy and within regulatory timelines.
  
• Ensure timely communication and proper documentation for all appeal decisions.
  
• Maintain a strong understanding of policy guidelines and appeal procedures.
  

---

First Day Experience:
On your first day, you'll begin with structured onboarding and shadowing an experienced team member. This hands-on approach allows you to observe the appeal handling process in real-time while receiving guidance and support.

---

Preferred Background/Experience:
Candidates with prior experience in the following areas tend to excel in this role:

• Healthcare claims processing
  
• Medical billing and coding
  
• Provider services or provider relations
  
• Appeals or grievance handling in a managed care environment
  

---

What Makes Our Team Special:
We are a collaborative and mission-driven team that values accuracy, empathy, and accountability. Our department plays a critical role in ensuring members and providers receive fair and timely resolution of their concerns. You'll be joining a supportive environment where continuous learning, clear communication, and team camaraderie are central to our success.

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.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.

Interested candidates please send resume in Word format Please reference job code 238973 when responding to this ad.

---