Grievance & Appeals Coordinator I

Grievance & Appeals Coordinator I

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

Position Title: [Grievance & Appeals Coordinator I]

Location: [Remote-CST]

Anticipated Start Date: [06/16/2025]

Please note this is the target date and is subject to change. BCforward will send official notice ahead of a confirmed start date.

Expected Duration: [3 Months Contract]

Job Type: [FULL TIME (>%3D30 HRS WEEKLY)/PART TIME (<30 HRS WEEKLY)], [POSSIBLE OF EXTENSION], [REMOTE]

Pay Range: [$20] - [$21]

Please note that actual compensation may vary within this range due to factors such as location, experience, and job responsibilities, and does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.).

Requirements:

• 2+ years of experience in grievances/appeals, claims processing, or related managed care environment.
• Background in healthcare claims processing or provider appeals

Job Description:

Position Purpose

Analyze and resolve verbal and written claims and authorization appeals from providers. Pursue resolution of formal grievances from members. This position plays a key role in maintaining regulatory compliance and ensuring member and provider satisfaction by responding accurately and timely to appeals and grievances.

Key Responsibilities

• Analyze and process provider and member complaints, grievances, and appeals (verbal and written)
• Prepare response letters in accordance with regulatory and internal guidelines
• Maintain detailed and accurate files on individual appeals and grievances
• Coordinate Grievance and Appeals Committee meetings (as needed)
• Support pay-for-performance programs through data entry, tracking, and research
• Assist with HEDIS production functions such as data entry, provider outreach, and claims research
• Manage high volumes of documentation including copying, faxing, scanning, and organizing mail
• Interface with internal departments, external vendors, and providers as necessary
• Notify members/providers of decisions following vendor review of appeals

Performance Expectations

• Complete a minimum of 2 appeals per day
• Ensure accuracy, timeliness, and compliance with state and federal guidelines
• Maintain a high level of team collaboration and communication

Required Qualifications

• High School Diploma or equivalent
• 2+ years of experience in grievances/appeals, claims processing, or related managed care environment
• Strong computer skills (especially Microsoft Word)
• Strong oral and written communication skills
• Problem-solving ability and attention to detail

Preferred Qualifications

• Associate's degree
• Background in healthcare claims processing or provider appeals

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.

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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 238766 when responding to this ad.

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