Grievance & Appeals Coordinator.

Pyramid Consulting, Inc; Chicago (IL); Remote; USD 80,000 - 100,000; Full time

Job summary

A leading healthcare company is seeking a Grievance & Appeals Coordinator for a remote contract position. This role involves managing claim disputes, analyzing grievances, and supporting performance programs. Candidates should have experience in managed care and strong problem-solving skills.

Benefits

Health insurance (medical, dental, vision)

401(k) plan

Paid sick leave

Qualifications

• 2+ years grievance or appeals, claims or related managed care experience.
• Strong oral and written communication skills.
• High attention to detail and problem-solving skills.

Responsibilities

• Handle intake claim disputes and create acknowledgment letters.
• Analyze and resolve claims and authorization appeals.
• Maintain files on individual appeals and grievances.

Skills

Grievance handling

Claims management

Problem solving

Education

High school diploma or equivalent

Associate’s degree preferred

Job description

Immediate need for a talented Grievance & Appeals Coordinator. This is a 06+months Contract to Hire opportunity with long-term potential and is located in Arizona(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID: 25-76789

Pay Range: $22 - $23/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Shifts: M-F 8-5
• Handling intake claim disputes. Will research mail and scan things in.
• Will create the acknowledgement letter that goes to the provider.
• Will also build authorizations for medical review.
• Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.
• 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.

Key Requirements and Technology Experience:

• Key Skills: 2+ years grievance or appeals, claims or related managed care experience.
• Handling intake claim disputes.
• Will research mail and scan things in.
• Will create the acknowledgement letter that goes to the provider.
• Will also build authorizations for medical review.
• AZ Medicaid or healthcare administration
• Claims background, reviewing reconsiderations. Certified professional coders.
• 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.

Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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