Remote Medicare Appeals & Grievance Specialist

View Moreicons; Northern (KY); Hybrid; USD 37,000 - 52,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Life Insurance

Disability insurance

FSA

EAP

401(k)

Job summary

Sagility (BroadPath, a Sagility Company) is seeking an Appeals and Grievance Specialist to join the remote team. The role reviews, investigates and resolves complaints, grievances, and appeals from members and providers, serving as the primary contact through resolution. Schedules, pay rates, and program details vary by client needs.

Base pay starts at $18/hour with weekly pay. Schedules may be Mon-Fri 8am-5pm PT, assigned by business needs.

Qualifications

• 1+ year of Medicare Appeals and Grievance or Medicare Claims experience required
• Experience with Medicare Part C or Part D preferred
• Familiarity with Windows based computer systems and the ability to learn new applications
• Strong technical and keyboarding skills
• Excellent verbal and written communication skills
• Ability to stay focused and productive in repetitive task-based work
• High School Diploma or equivalent

Responsibilities

• Manage and resolve complaints, grievances, and appeals from members and providers
• Serve as the primary contact throughout the investigation and resolution process
• Send acknowledgments and provide clear education on the grievance and appeal process
• Gather relevant information and research case details to determine an appropriate resolution
• Conduct fair, accurate, and timely case investigations
• Communicate resolutions to appropriate internal and external parties
• Ensure all required documentation is completed and maintained
• Follow established policies, procedures, and regulatory requirements
• Maintain productivity and quality standards in a structured workflow environment

Skills

Medicare Appeals/Grievance experience

Keyboarding skills

Verbal and written communication

Windows familiarity

Education

High School Diploma or equivalent

Tools

Windows

Job description

Sagility (BroadPath, a Sagility Company) is seeking an Appeals and Grievance Specialist to join the remote team. The role reviews, investigates and resolves complaints, grievances, and appeals from members and providers, serving as the primary contact through resolution. Schedules, pay rates, and program details vary by client needs.

Base pay starts at $18/hour with weekly pay. Schedules may be Mon-Fri 8am-5pm PT, assigned by business needs.