Grievance Resolution Specialist (Remote)

Healthfirst; Texas; Remote; USD 51,000 - 75,000; Full time

Benefits offered by this job

Medical/Dental/Vision coverage

401k contributions

Incentive and recognition programs

Life insurance

Job summary

Healthfirst is seeking a Grievance Specialist to join the Appeals & Grievances team. This remote role handles member grievances across Medicare, Medicaid, CHPlus, SHP, QHP, EP, and CompleteCare with a focus on timely, accurate resolutions.

You will research issues across departments, coordinate with external vendors, and draft compliant letters. Strong MS Office and case-tracking skills are essential.

Qualifications

• HS Diploma or GED required.
• Understanding of utilization management processes and impact on access to care and claims payment.
• Proficient in Microsoft Office Suite (Excel, Word, PowerPoint, Outlook) and case-tracking systems.

Responsibilities

• Manage a caseload of grievances from acknowledgement to resolution.
• Collaborate with internal departments to identify root causes and resolve issues.
• Work with external vendors to address subcontracted services and benefits.
• Draft clear acknowledgement and resolution letters aligned with regulatory timelines.
• Ensure accurate case documentation per policies and audit standards.
• Participate in meetings, audits, trainings, and performance reviews.
• Meet department production and quality metrics.

Skills

Microsoft Office Suite

Utilization management understanding

Education

HS Diploma or GED

Bachelor’s degree or equivalent healthcare experience (preferred)

Tools

Case tracking systems

Job description

Healthfirst is seeking a Grievance Specialist to join the Appeals & Grievances team. This remote role handles member grievances across Medicare, Medicaid, CHPlus, SHP, QHP, EP, and CompleteCare with a focus on timely, accurate resolutions.

You will research issues across departments, coordinate with external vendors, and draft compliant letters. Strong MS Office and case-tracking skills are essential.