Appeals and Grievance Coordinator {168612}

We are seeking a detail-oriented Appeals and Grievance Coordinator to support members through the resolution of healthcare concerns. In this role, you will investigate, review, and resolve non-complex grievances while ensuring compliance with regulatory guidelines and internal policies.

This is a great opportunity for candidates with healthcare customer service, insurance, or care coordination experience looking to grow in managed care.

• Review, investigate, and resolve member grievances in a timely manner
• Respond to phone and written inquiries from members, providers, and representatives
• Interpret and explain health plan benefits, policies, and procedures
• Research and apply clinical guidelines, policies, and regulatory requirements
• Maintain accurate case documentation in internal systems
• Communicate case updates and resolutions clearly to members
• Ensure compliance with state and federal healthcare regulations
• Collaborate with internal teams to resolve issues and improve service delivery
• Manage a caseload of 60 cases per month

• High School Diploma or equivalent required
• Associate’s or Bachelor’s degree preferred
• 1–2 years of experience in:
  • Healthcare
  • Managed care
  • Insurance
  • Hospital or clinical support setting
• Strong knowledge of:
  • Medical terminology
  • Healthcare processes or insurance
• Excellent communication and documentation skills
• Ability to work independently and manage multiple cases

• Appeals & grievances OR prior authorization
• Call center or high-volume customer service
• Health plan, PBM, or insurance environment

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