Remote Grievance & Appeals Specialist I (Contract)

Pyramid Consulting, Inc; Georgia (VT); Remote; USD 30,307 - 30,996; Full time

Benefits offered by this job

Health insurance (medical, dental, vision)

401(k) plan

Paid sick leave

Job summary

A leading healthcare consulting firm is seeking a Grievance & Appeals Coordinator I for a contract role. Responsibilities include managing member appeals, ensuring compliance with CMS guidelines, and maintaining a high productivity benchmark. Candidates need a high school diploma and 1+ year experience in Grievance & Appeals. The job offers competitive pay and requires strong analytical skills with regulatory knowledge.

Qualifications

• At least 1+ years’ experience with Grievance & Appeals.
• Formal written communication; accuracy with data entry.
• Experience in a production environment.

Responsibilities

• Acknowledge and resolve member appeals within established turnaround times.
• Ensure regulatory compliance by managing time-sensitive member appeals.
• Maintain or exceed 98% compliance rate for all appeal files.

Skills

Regulatory knowledge (CMS, Medicaid, NCQA)

Prioritization and time management skills

Interpersonal skills

Technology proficiency

Education

High school diploma or equivalent

Job description

A leading healthcare consulting firm is seeking a Grievance & Appeals Coordinator I for a contract role. Responsibilities include managing member appeals, ensuring compliance with CMS guidelines, and maintaining a high productivity benchmark. Candidates need a high school diploma and 1+ year experience in Grievance & Appeals. The job offers competitive pay and requires strong analytical skills with regulatory knowledge.