Hybrid Grievances & Appeals Specialist

VNS Health; New York (NY); Hybrid; USD 66,000 - 80,000; Full time

Benefits offered by this job

Referral bonus opportunities

Generous PTO (30 days) + 9 holidays

Health insurance for you and loved one

Employer-matched retirement savings

FSAs for healthcare and dependent care

Tuition reimbursement

Career growth & internal mobility

CEU credits & advancement

Job summary

VNS Health seeks a Grievance and Appeals Specialist to resolve grievances and appeals for MLTC, MA, FIDA, and Select Health plans in a hybrid New York environment. The role ensures regulatory compliance, timely processing, and accurate record-keeping of decisions.

Responsibilities include investigating complex cases, coordinating with enrollees, providers, and internal departments, and assisting with data collection and reporting.

Qualifications

• Bachelor's degree in health/human services, healthcare or business administration or related field or equivalent work experience required.
• Master's Degree in public health or health-related field preferred.

Responsibilities

• Develops and maintains knowledge of state and federal regulatory requirements related to grievances and appeals for Medicare managed care, Medicaid, and related products.
• Investigates and reviews routine and complex grievances and appeals, communicates key points to enrollees, providers and health plan departments.
• Coordinates resolution of grievances and appeals ensuring timely follow-up and regulatory compliance; documents actions and rationale.

Skills

Verbal communication

Written communication

Microsoft Word and Excel

Typing skills

Education

Bachelor's degree in health/human services, healthcare or business administration

Master's degree in public health or health-related field (preferred)

Job description

VNS Health seeks a Grievance and Appeals Specialist to resolve grievances and appeals for MLTC, MA, FIDA, and Select Health plans in a hybrid New York environment. The role ensures regulatory compliance, timely processing, and accurate record-keeping of decisions.

Responsibilities include investigating complex cases, coordinating with enrollees, providers, and internal departments, and assisting with data collection and reporting.