BusinessOperations - Grievance & Appeals Coordinator I - 210056

Job Title: BusinessOperations - Grievance & Appeals Coordinator I - 210056

Location: (City, State)

Duration: Contract - 12 months

Pay Range: $21/hr $22.5/hr (W2)

Job ID: 372703

About BCforward

BCforward is a leading global IT consulting and workforce solutions firm providing services and support to Fortune 500 and government clients. Founded in 1998, BCforward has grown with our customers needs into a full-service business solutions provider. With delivery centers and offices across North America and India, we take pride in building long-term relationships and delivering excellence through innovation, collaboration, and integrity.

Job Description

We are seeking a Grievance & Appeals Coordinator I to join our team. The ideal candidate will have experience in grievance and appeals processing, claims research, and managed care operations and a proven ability to analyze and resolve member and provider complaints while maintaining accurate documentation and timely communications.

Responsibilities:

• Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal member grievances.
• Gather, analyze, and report member and provider complaints, grievances, and appeals.
• Prepare clear response letters for member and provider complaints, grievances, and appeals.
• Maintain organized files on individual appeals and grievances to support audit readiness.
• Coordinate Grievance and Appeals Committee activities as assigned.
• Support pay-for-performance programs through data entry, tracking, organization, and research.
• Assist with HEDIS production functions, including data entry, outreach to provider offices, and claims research.
• Manage large volumes of documents, including copying, faxing, scanning, and processing incoming mail.

Required Skills & Qualifications:

• High school diploma or equivalent. Associate's degree preferred.
• 2+ years of experience in grievances and appeals, claims, or related managed care functions.
• Strong oral and written communication skills with attention to detail.
• Proven problem-solving and analytical abilities.
• Proficiency with data entry, document management, and basic office technologies.

Preferred Skills:

• Experience with HEDIS processes and provider outreach.
• Background in pay-for-performance programs or quality improvement.

Why BCforward?

At BCforward, we believe in advancing lives and careers. When you join our team, you gain access to:

• Competitive compensation and benefits.
• Opportunities for growth with global clients.
• A supportive, inclusive culture that values innovation and people.
• Exposure to cutting-edge technologies and projects.

About Our Commitment

BCforward is an equal opportunity employer. We value diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability, or veteran status.

Interested? Apply Now!

If this sounds like the right opportunity for you, please apply with your most recent resume.