Grievance & Appeals Coordinator

Pyramid Consulting, Inc; United States; On-site; USD 30,307 - 31,684; Full time

Benefits offered by this job

Health insurance (medical, dental, vision)

401(k) plan

Paid sick leave

Job summary

A leading healthcare consulting firm is seeking a Grievance & Appeals Coordinator for a remote position. This role involves processing and resolving member appeals and grievances while maintaining compliance with healthcare regulations and quality standards. Candidates should have 2-3 years of relevant experience, strong attention to detail, and excellent communication skills. The position offers a competitive pay range of $22.00 - $23.00/hour and various employee benefits, including health insurance and a 401(k) plan.

Qualifications

• 2-3 years of experience in appeals and grievance.
• Strong attention to detail and accuracy in documentation.
• Knowledge of healthcare regulations or compliance requirements.
• Familiarity with Medicare or Medicaid guidelines.

Responsibilities

• Review and resolve member appeals and grievance cases.
• Ensure accurate documentation and compliance with standards.
• Communicate with internal teams to support case resolution.
• Identify opportunities for process improvement.

Skills

Experience in appeals and grievance

Healthcare administration

Health insurance operations

Customer service in a regulated environment

Strong attention to detail

Knowledge of healthcare regulations

Communication skills

Analytical thinking

Problem-solving ability

Familiarity with Medicare/Medicaid guidelines

Education

High School Diploma or equivalent

Tools

Microsoft Word

Excel

Outlook

Teams

OneDrive

Job description

Immediate need for a Grievance & Appeals Coordinator. This is a 12+ Month Contract opportunity with long-term potential and is US(Remote). Please review the job description below and contact me ASAP if you are interested.

Job Diva ID: 26-07046

Pay Range: $22.00 - $23.00/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

• Review, process, and resolve member appeals and grievance cases in accordance with company policies and regulatory requirements
• Ensure accurate documentation and case tracking while meeting quality and compliance standards
• Communicate with internal teams to gather required information and support case resolution
• Maintain clear and professional communication throughout the case management process
• Identify opportunities to improve processes and contribute to continuous improvement initiatives
• Ensure cases are handled within required timelines while maintaining high accuracy
• Support team collaboration to improve operational efficiency and customer satisfaction

Key Requirements and Technology Experience

• Key skills: 2-3 years of experience in appeals and grievance, Healthcare administration, Health insurance operations, and Customer service within a regulated environment
• Strong attention to detail and ability to maintain accuracy when reviewing case documentation
• Knowledge of healthcare regulations or compliance requirements
• Familiarity with Medicare or Medicaid guidelines
• Strong communication and collaboration skills
• Analytical thinking and problem-solving ability
• Comfortable using standard office tools such as Microsoft Word, Excel, Outlook, Teams, and OneDrive
• Experience handling complex or compliance-related cases
• Strong written communication and letter-writing skills
• Experience coordinating projects or working with cross-functional teams in a fast-paced environment
• High School Diploma or equivalent

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, colour, 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.