Senior Paralegal II - Quality Appeals & Grievances

CareSource; New York (NY); Remote; USD 55,000 - 87,000; Full time

Job summary

CareSource seeks a Paralegal II focused on Quality Appeals & Grievances in New York. You will provide legal research, case administration, and data-driven support to regulatory readiness under leadership guidance.

In this role you will draft responses, audit appeal documentation, analyze outcomes, and help produce reports and dashboards to drive quality improvement and compliance across the program.

Qualifications

• High School or GED required.
• Associates degree preferred.
• Two (2) years paralegal, legal support, managed care, healthcare compliance, appeals, grievances, or related experience required.

Responsibilities

• Provide paralegal, research, and administrative support to Quality Appeals & Grievances leadership and team members.
• Respond to internal and external inquiries as directed, with appropriate review and oversight.
• Initiate, gather, and analyze information related to internal appeal decisions.
• Conduct research utilizing legal databases, regulatory guidance, industry resources, and approved organizational technologies to support appeal determinations and rebuttal preparation.
• Research, analyze, and support the preparation of responses, documentation, and supporting records related to External Reviews, Fair Hearings, audits, and regulatory inquiries.
• Analyze internal and external appeal outcomes, identify trends, and prepare reports and dashboards related to case volume, overturn rates, review findings, reviewer qualifications, and other key performance indicators.
• Develop and deliver weekly, monthly, and quarterly reports based on appeal and review data.
• Audit Final Adverse Determination (FAD) letters and other appeal and grievance determinations to ensure regulatory compliance and quality standards are met.

Skills

MS Office

Legal research

Data analysis

Regulatory knowledge

Analytical thinking

Communication

Quality assurance

Project coordination

Independent work

Stakeholder collaboration

Education

High School or GED

Associates degree preferred

Two years paralegal experience

Tools

Legal databases

Regulatory resources

AI-enabled tools

Job description

CareSource seeks a Paralegal II focused on Quality Appeals & Grievances in New York. You will provide legal research, case administration, and data-driven support to regulatory readiness under leadership guidance.

In this role you will draft responses, audit appeal documentation, analyze outcomes, and help produce reports and dashboards to drive quality improvement and compliance across the program.