Remote Grievance & Appeals Specialist

Healthfirst; United States; Remote; USD 55,000 - 75,000; Full time

Benefits offered by this job

Remote work

Flexible schedule

Job summary

Healthfirst is seeking a Grievance Specialist to join its Appeals & Grievances team in a fully remote position. You will manage and resolve member complaints across Medicare, Medicaid, and other Healthfirst programs, coordinating with internal teams and external partners to ensure timely, compliant resolutions.

The role emphasizes detailed investigation, accurate documentation, and clear communication with members. Strong MS Office skills and knowledge of healthcare programs are essential.

Qualifications

• Bachelor's degree or equivalent in healthcare, public health, or related field preferred.
• Strong written and verbal communication skills required.
• Proficiency in Microsoft Office and case tracking systems.
• Understanding of utilization management and its impact on access and claims.
• Ability to work independently in a remote environment.
• Experience with LTSS (long-term services and supports) is a plus.

Responsibilities

• Manage grievance cases from acknowledgement through resolution and closure.
• Investigate concerns by coordinating with internal departments and external partners.
• Prepare compliant resolution communications and notifications to members.
• Maintain accurate case documentation per policies and regulatory guidelines.
• Monitor progress and ensure timely completion of cases.
• Participate in team meetings, quality reviews, and training.

Skills

Written and verbal communication

MS Office proficiency

Case tracking systems

Utilization management understanding

Ability to manage multiple cases

Remote work discipline

Education

Bachelor's degree or equivalent in healthcare/public health/related field

Tools

Microsoft Office Suite

Case tracking systems

Job description

Healthfirst is seeking a Grievance Specialist to join its Appeals & Grievances team in a fully remote position. You will manage and resolve member complaints across Medicare, Medicaid, and other Healthfirst programs, coordinating with internal teams and external partners to ensure timely, compliant resolutions.

The role emphasizes detailed investigation, accurate documentation, and clear communication with members. Strong MS Office skills and knowledge of healthcare programs are essential.