Remote Appeals & Grievance Coordinator

E2E Alignment Healthcare USA, LLC; California (MO); Hybrid; USD 45,000 - 67,000; Full time

Job summary

Alignment Health is seeking an Appeals & Grievance Coordinator to manage the day-to-day tracking and investigation of member grievances and appeals within the Member Services Department. This fully remote role requires timely, unbiased processing and clear communication with members and providers.

The ideal candidate has 2+ years of data entry and 3+ years of customer service experience, with a high school diploma. Healthcare/Medicare knowledge is preferred; bilingual English/Spanish is a plus.

Qualifications

• Two years of data entry and general office background.
• Three years of customer service experience.
• Minimum 1 year in Member Services or similar experience.

Responsibilities

• Acknowledges receipt of all grievances and CTM entries.
• Gathers information from member/provider and resolves per policies.
• Composes written correspondence per CMS guidelines.
• Conducts unbiased, timely investigations of grievances/appeals.
• Documents all actions taken and communicates resolutions.
• Ensures processing adheres to CMS and plan policies.
• Prepares files for Medical Director Review and external review as needed.
• Prepares clear case histories for committee and Board meetings.

Skills

Data entry

Customer service

Member services

Healthcare knowledge

Bilingual (English/Spanish)

10-key by touch

Education

High School diploma or GED

Associate degree

Tools

10-key by touch

Job description

Alignment Health is seeking an Appeals & Grievance Coordinator to manage the day-to-day tracking and investigation of member grievances and appeals within the Member Services Department. This fully remote role requires timely, unbiased processing and clear communication with members and providers.

The ideal candidate has 2+ years of data entry and 3+ years of customer service experience, with a high school diploma. Healthcare/Medicare knowledge is preferred; bilingual English/Spanish is a plus.