Remote Grievance & Appeals Specialist III

CareSource; United States; Remote; USD 47,000 - 76,000; Full time

Job summary

CareSource is seeking a Grievance & Appeals Specialist III to process and respond to claim appeals and disputes, providing subject matter expertise in coding denials. This remote role collaborates with leadership across departments and supports timely, accurate review of grievances.

The specialist will document outcomes, identify issues, and assist with state inquiries while ensuring compliance with HIPAA and state regulations. Strong communication and multitasking are essential.

Qualifications

• High school diploma or equivalent required.
• Associates Degree or equivalent years of relevant work experience preferred.
• Three years of healthcare customer service, claims, compliance or related experience required, including one year of coding experience.

Responsibilities

• Process and respond to claim appeals and disputes.
• Prepare appeals for clinical review and track outcomes.
• Review appeals daily for validation and document results in Facets.

Skills

Microsoft Word

Microsoft Excel

Microsoft Access

Attention to detail

Customer service

Communication skills

Time management

Multitask

Problem solving

Technical writing

Education

High school diploma or equivalent

Associate's Degree or equivalent

Tools

Facets system

Microsoft Access

Job description

CareSource is seeking a Grievance & Appeals Specialist III to process and respond to claim appeals and disputes, providing subject matter expertise in coding denials. This remote role collaborates with leadership across departments and supports timely, accurate review of grievances.

The specialist will document outcomes, identify issues, and assist with state inquiries while ensuring compliance with HIPAA and state regulations. Strong communication and multitasking are essential.