Hybrid Paralegal II — Quality Appeals & Grievances

CareSource Management Services; New York (NY); Remote; USD 75,079,000 - 120,264,000; Full time

Job summary

CareSource in New York is seeking a Paralegal II to support the Quality Appeals & Grievances function with legal research, analysis, and reporting. You will assist with drafting responses, auditing documentation, and providing insights to improve regulatory readiness under leadership guidance.

The role emphasizes data-driven reporting, compliance audits, and collaboration with internal stakeholders to ensure accurate case management and timely resolutions in a fast-paced environment.

Qualifications

• High School or GED required; associates degree preferred.
• Two years paralegal or related healthcare compliance experience requested.
• Proficiency with MS Office and legal research tools.

Responsibilities

• Provide paralegal, research, and administrative support to Quality Appeals & Grievances.
• Respond to inquiries with appropriate review and oversight.
• Initiate and analyze information related to internal appeal decisions.
• Conduct legal research to support determinations and rebuttals.
• Prepare responses and supporting records for External Reviews and audits.
• Analyze appeal outcomes and develop reports and dashboards.
• Audit FAD letters for regulatory compliance and quality standards.
• Identify risks and opportunities for process improvement.
• Support department leadership and participate in special projects.
• Perform additional job-related duties as needed.

Skills

Microsoft Office Suite

Legal research tools

Healthcare regulations

Managed care operations

Analytical skills

Quality assurance & audits

Data analysis

Written & verbal communication

Customer service focus

Organizational skills

AI-enabled tools

Independent work

Education

High School or GED

Associates degree preferred

Two years paralegal/related experience

Tools

Legal databases

Job description

CareSource in New York is seeking a Paralegal II to support the Quality Appeals & Grievances function with legal research, analysis, and reporting. You will assist with drafting responses, auditing documentation, and providing insights to improve regulatory readiness under leadership guidance.

The role emphasizes data-driven reporting, compliance audits, and collaboration with internal stakeholders to ensure accurate case management and timely resolutions in a fast-paced environment.