Grievance And Appeals Coordinator

TEKsystems; United States; Remote; USD 27,000 - 39,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) plan

Life Insurance

Disability

Health Savings Account

Paid time off

Job summary

TEKsystems is urgently hiring multiple remote Grievances and Appeals coordinators. Open to candidates based in CA, AZ, NV, NM, or TX. Requires 1 year grievances/appeals experience; reliable internet; Medicare Advantage preferred.

Role pays $24/hr and is fully remote in a contract capacity. Responsibilities include investigating grievances, gathering documentation, communicating with members/providers, and coordinating with RN/management.

Qualifications

• Must have at least 1 year of recent grievances and appeals experience.
• Reliable internet and experience working remotely.
• Medicare Advantage plan is highly preferred.
• 2-3 years of experience within grievances and appeals in a healthcare setting.
• Basic technical skills: Microsoft Word, Excel, Outlook.

Responsibilities

• Investigates member grievances and appeals by gathering documentation from internal departments, PO, and others.
• Communicates with members or providers to request information and follow up as needed.
• Refers case to RN or management as needed.
• Tracks movement of cases through SCAN units to meet timelines.
• Responds to information requests from regulatory agencies within required timeframes.
• Closes cases within designated regulatory time requirements and sends communications.
• Maintains knowledge of SCAN benefit structure relevant to Grievances and Appeals.
• Uses department procedures and training materials; reports barriers to supervisor.
• Covers weekend on-call rotation and preserves member privacy.
• Adheres to quality, compliance and regulatory standards.

Skills

Grievances

Appeals

Healthcare

Medicare

Managed Care

Medical Terminology

Education

High School Diploma

Tools

MS Office

IKA

MHK

QNXT

Job description

Urgently hiring multiple REMOTE Grievances and Appeals coordinators (Must be based inCA, AZ, NV, NM, or TX)

Must have:

• Must have at least 1 year of recent grievances and appeals experience
• Reliable internet and experience working remotely
• Medicare Advantage plan is highly preferred

ESSENTIAL JOB RESULTS:

Investigates member grievances and appeals by gathering supporting documentation from internal departments, contracted Provider Organizations (PO), and non-contracted entities as indicated.

Communicates with the members or providers to request and gather pertinent information. Follows up as needed and documents accordingly.

Refers case to RN or management as needed.

Tracks and monitors movement of assigned cases through SCANs functional units and systems, to ensure compliance with designated timelines.

Responds to requests for information from all regulatory agencies within required timeframes.

Responds to and closes cases within designated regulatory time requirements as identified by case types. Generates and sends appropriate communications.

Understands SCAN benefit structure and maintains current and additional information as it relates to Grievances and Appeals services.

Utilizes department desktop procedures, workflows, job aids and training material. Identifies barriers to work processes and brings to the attention of the supervisor/manager.

Covers week-end on-call rotation as assigned.

Maintains the members right to privacy and protects SCAN operations by keeping information confidential.

Adheres to all quality, compliance and regulatory standards to achieve HCS and SCAN outcomes.

Skills

Claims, Grievances, Appeals, Healthcare, Medical Terminology, Medicare, Managed Care

Top Skills Details

Claims,Grievances,Appeals,Healthcare,Medical Terminology,Medicare,Managed Care

Additional Skills & Qualifications

High School Diploma, Required

2 - 3 years of experience within grievances and appeals in a healthcare, health plan, or managed care setting

Medicare Advantage plan is highly preferred

Technical - Basic technical skills : Microsoft Office (Word, Excel, PowerPoint, Outlook, Teams) are required.

IKA, MHK, or QNXT preferred.

Experience Level

Intermediate Level

Job Type & Location

This is a Contract position based out of Phoenix, AZ.

Pay and Benefits

The pay range for this position is $24.00 - $24.00/hr.

Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

Eligibility requirements apply to some benefits and may depend on your jobclassification and length of employment. Benefits are subject to change and may besubject to specific elections, plan, or program terms. If eligible, the benefitsavailable for this temporary role may include the following:Medical, dental & visionCritical Illness, Accident, and Hospital401(k) Retirement Plan Pre-tax and Roth post-tax contributions availableLife Insurance (Voluntary Life & AD&D for the employee and dependents)Short and long-term disabilityHealth Spending Account (HSA)Transportation benefitsEmployee Assistance ProgramTime Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully remote position.

Application Deadline

This position is anticipated to close on Oct 2, 2026.

About TEKsystems

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

About TEKsystems and TEKsystems Global Services

Were a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. Were a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. Were strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. Were building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.