Appeals & Grievance Specialist (remote)

Cognizant; Providence (RI); Remote; USD 100,000 - 125,000; Full time

Job summary

A healthcare solutions provider is looking for a remote Appeals & Grievance Specialist with 2 to 3 years of experience. The role involves reviewing claims and managing healthcare processes to improve efficiency and patient satisfaction. Candidates should possess strong technical skills in MS Excel and effective communication skills. This full-time position offers an hourly rate between $17.00 and $18.00, along with benefits including medical insurance and a 401(k) plan.

Benefits

Medical/Dental/Vision/Life Insurance

Paid holidays plus Paid Time Off

401(k) plan and contributions

Long-term/Short-term Disability

Paid Parental Leave

Employee Stock Purchase Plan

Qualifications

• Experience in IVR and Healthcare Call Center domains preferred.
• Strong understanding of Claims, Appeals, and Medical Benefits.
• Proficiency in data entry and transcription.

Responsibilities

• Review Appeals & Grievances for pending claims.
• Determine legitimacy of appeals or grievances.
• Manage and optimize healthcare processes.

Skills

Technical skills in MS Excel

Good written and verbal communication skills

Ability to maintain integrity and confidentiality

Education

High School Diploma or GED

Job description

Appeals & Grievance Specialist (remote)

This is a remote position open to any qualified applicant in the United States.

Job Summary

We are seeking a dedicated Appeals & Grievance Specialist with 2 to 3 years of experience to join our team. The ideal candidate will have strong technical skills in MS Excel and preferably experience in IVR and Healthcare Call Center domains. This is a work-from-home position with day shifts and no travel is required. The role involves managing and optimizing healthcare processes to improve efficiency and patient satisfaction.

Responsibilities

• Reviewing available Appeals & Grievances for the pending claims to verify due process was followed.
• Determine if the appeal or Grievance is legitimate.
• A strong understanding of Claims, Appeals and Medical Benefits.
• Referring suspicious or complicated Claims to investigators.
• Collaborating with other professionals to determine the urgency on the Appeal validity and cause.
• Manage and optimize healthcare processes to ensure efficiency and patient satisfaction.
• Utilize MS Excel to analyze and interpret data creating reports and dashboards for better decision-making.
• Communicate effectively with team members and other departments to ensure seamless operations.
• Contribute to the overall success of the company by enhancing patient satisfaction and operational efficiency.

Qualifications

• High School Diploma or GED is Required.
• Proficiency in computer skills including typing speed and accuracy
• Good written and verbal communication skills
• Ability to maintain a high level of integrity and confidentiality of medical information
• Knowledge of data entry and transcription

Salary and Other Compensation

Applications will be accepted until September 22, 2025.

The hourly rate for this position is between $17.00 – 18.00 per hour, depending on experience and other qualifications of the successful candidate.

This position is also eligible for Cognizant’s discretionary annual incentive program, based on performance and subject to the terms of Cognizant’s applicable plans.

Benefits

• Medical/Dental/Vision/Life Insurance
• Paid holidays plus Paid Time Off
• 401(k) plan and contributions
• Long-term/Short-term Disability
• Paid Parental Leave
• Employee Stock Purchase Plan

Disclaimer: The hourly rate, other compensation, and benefits information is accurate as of the date of this posting. Cognizant reserves the right to modify this information at any time, subject to applicable law.

Cognizant is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.