BusinessOperations - Grievance & Appeals Coordinator I - 210056

Candidate Requirements Required: High school diploma or equivalent Preferred: Required: Preferred: Years of experience required: Minimum of 2 years of experience in Grievance and Appeals operations within a healthcare or managed care environment, with a strong understanding of appeals, case processing, regulatory requirements, and applicable turnaround times. The role requires extensive investigation across multiple systems, coordination with Clinical, Claims, Utilization Management, providers, and leadership, and the ability to manage complex, high-priority cases with significant regulatory and operational impact.

Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.

Education/Experience: High school diploma or equivalent. Associate s degree preferred. 2+ years grievance or appeals, claims or related managed care experience. Strong oral, written, and problem solving skills.

" Gather, analyze and report verbal and written member and provider complaints, grievances and appeals
" Prepare response letters for member and provider complaints, grievances and appeals
" Maintain files on individual appeals and grievances
" May coordinate the Grievance and Appeals Committee
" Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information
" Assist with HEDIS production functions including data entry, calls to provider s offices, and claims research.
" Manage large volumes of documents including copying, faxing and scanning incoming mail

EEO:

Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.

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Story Behind the Need
1. What is the purpose of this team? The PAR Retro Appeals & Escalations Coordinator is responsible for managing retrospective authorization appeals and escalated cases to ensure timely, accurate, and compliant resolution. This role conducts detailed case research, reviews authorization and claims history, obtains required documentation, and coordinates with internal and external stakeholders to facilitate case outcomes. 2. What is driving this need? Additional staffing is needed to support growing PAR Retro Appeals and Escalations inventories while ensuring compliance with regulatory turnaround times and quality standards. Adding a dedicated associate will strengthen coverage, improve workload distribution, and mitigate the risk of delayed processing and regulatory noncompliance. 3. The Par Retro and Escalation team operates in a fast-paced, deadline-driven environment where accuracy, accountability, collaboration, and effective prioritization are essential. Associates work closely with Intake/Triage, Clinical, Escalations, and other operational teams to ensure cases are appropriately identified and routed. The team emphasizes cross-training, independent problem-solving, proactive communication, and shared responsibility for daily inventory. 4. Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative? This request addresses an immediate operational staffing need within Medicare Appeals Par Retro and Escalation rather than a new project or broad hiring initiative. However, additional staffing needs may be identified as workload volumes, staffing capacity, and operational responsibilities continue to be evaluated.
Typical Day in the Role
Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD). What are performance expectations/metrics? What makes this role unique?	1. The coordinator monitors assigned inventory, identifies and escalates risks, maintains audit-ready documentation, and ensures adherence to regulatory and organizational requirements. The position requires strong analytical skills, attention to detail, effective communication, and the ability to manage multiple priorities in a fast-paced environment. 2. Performance will be measured by daily productivity, accuracy of case classification and routing, timely processing of incoming submissions, and adherence to established turnaround times and quality standards. Associates are expected to independently manage assigned work, maintain minimal aging inventory, proactively communicate barriers, and consistently meet productivity and compliance expectations. 3. The role requires extensive investigation across multiple systems, coordination with Clinical, Claims, Utilization Management, providers, and leadership, and the ability to manage complex, high-priority cases with significant regulatory and operational impact. It requires strong attention to detail, sound judgment, multitasking, and the ability to navigate multiple systems while managing competing priorities in a high-volume environment.
Candidate Requirements
Required: High school diploma or equivalent			Preferred:
Required:			Preferred:
Years of experience required: Minimum of 2 years of experience in Grievance and Appeals operations within a healthcare or managed care environment, with a strong understanding of appeals, case processing, regulatory requirements, and applicable turnaround times. Disqualifiers: No Appeals or Grievance experience Additional qualities to look for: Strong Attention to Detail and Accuracy, Critical Thinking and Independent Decision-Making, Ability to navigate multiple systems & Organization, Prioritization, and Adaptability, work from home experience
Top 3 must-have hard skills stack-ranked by importance	1	Medicare Appeals Experience
	2	Analytical Research & Critical Thinking
	3	Inventory Management & Prioritization
Candidate Review & Selection
Shortlisting process Candidate review & selection Interview information Onboard process and expectations	Projected Manager Candidate Review Date:			1-2 days post shortlisting
	Type of Interviews:			Teams on camera
	Required Testing or Assessment (by Vendor):			Basis Computer Skills test- intermediate- please include Outlook
Next Steps
Do you have any upcoming PTO?	10/23/2026
Colleagues to cc/delegate	N/A