Grievance & Appeals Coordinator I - 210056

Grievance & Appeals Coordinator I - 210056

BCforward is currently seeking a highly motivated Grievance & Appeals Coordinator I for an opportunity in Remote (Ohio residents preferred, Eastern Time Zone)!

Job Title: Grievance & Appeals Coordinator I

Location: Remote (Ohio residents preferred, Eastern Time Zone)
Start Date: August 18, 2025
Assignment Duration: 6 months (with potential for extension or conversion)
Pay Rate: $23.00/hour
Work Hours: Monday-Friday, 8:00 AM - 5:00 PM ET

Position Purpose:

The Grievance & Appeals Coordinator I is responsible for analyzing and resolving verbal and written claims and authorization appeals from providers, as well as pursuing the resolution of formal grievances from members. This role plays a critical part in ensuring timely, accurate, and regulatory-compliant handling of sensitive healthcare issues.

Key Responsibilities:

• Analyze and report verbal and written member and provider complaints, grievances, and appeals
• Draft and prepare accurate response letters in alignment with regulatory standards
• Maintain detailed and organized case files for appeals and grievances
• Support and coordinate the Grievance and Appeals Committee, as needed
• Perform data entry, tracking, and research to support pay-for-performance and HEDIS initiatives
• Contact provider offices and conduct claims research for HEDIS-related tasks
• Manage and process large volumes of documents (scanning, copying, faxing, etc.)

Daily Workflow:

• 60% Processing member grievance and appeal cases
• 20% System documentation and drafting correspondence
• 10% Researching case details and coordinating internally
• 10% Team huddles, training sessions, and quality reviews

This is a remote role with a structured, fast-paced, and compliance-driven environment. Candidates should be comfortable working independently while staying highly engaged with their team through Microsoft Teams and virtual check-ins.

Qualifications:

Education:

• High school diploma or equivalent (required)
• Associate degree (preferred)

Experience:

• Minimum 2 years of experience in grievances, appeals, claims, or related managed care functions
• Experience in healthcare regulatory compliance (e.g., CMS, NCQA) strongly preferred

Skills:

• Strong oral and written communication
• Excellent problem-solving abilities
• Accurate and efficient data entry skills
• Proficiency in case documentation systems
• Professional and concise written correspondence

Top 3 Required Skills (Stack-Ranked):

Regulatory Case Processing / Appeals & Grievances Workflow Knowledge

Data Entry & Documentation Systems Proficiency

Written Communication & Email Correspondence Skills

Ideal Candidate Traits:

• Self-motivated and detail-oriented
• Able to manage high volumes of cases and prioritize effectively
• Works independently with minimal supervision
• Communicates clearly and professionally across teams
• Flexible and adaptable to a dynamic, metric-driven environment

Interested candidates please send resume in Word format Please reference job code 241009 when responding to this ad.

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