Temporary Case Specialist- Grievance & Appeals Unit

Blue Cross & Blue Shield of Rhode Island; United States; Hybrid; USD 60,000 - 90,000; Full time

Benefits offered by this job

Flexible work arrangements (remote/hy‑

Paid time off

Tuition reimbursement

Student-loan repayment assistance

Health/dental/vision insurance

Mental health programs

Bonuses and investment plans

Volunteer time off

Job summary

BCBSRI in Providence, RI seeks a detail-oriented professional to investigate and resolve member and provider complaints, benefits and administrative appeals. You will maintain appeal records and ensure compliance with regulatory requirements.

Responsibilities include responding to inquiries, educating members about plan details, analyzing trends with internal teams, and supporting department audits and projects. A high school degree and 2–4 years in managed care are required.

Qualifications

• Written and verbal communications skills required.
• Knowledge of health insurance laws and regulations.
• Working knowledge of Microsoft Office including Excel and Word.
• General computer proficiency required.
• Good organization and time management skills.

Responsibilities

• Investigate and resolve member and provider complaints, benefits appeals, and administrative appeals for all company products.
• Maintain documentation of cases.
• Respond to inquiries and assist with special member cases and resolutions.
• Educate members to understand the plan.

Skills

Written and verbal communications

Microsoft Excel

Microsoft Word

General computer proficiency

Time management

Detail oriented

Organizational skills

Research data organization

Education

High school degree

Tools

Microsoft Office

Job description

Please email [e-mail] if you are a candidate seeking a reasonable accommodation for the application and/or interview process.

At BCBSRI, our greatest resource is our people. We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do—not just for our members, but for our employees as well. We recognize that to do your best work, you have to be your best self. It’s why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees. Our culture is one of belonging. We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you’re at in the organization, you’re an integral part of our team and your input, thoughts, and ideas are valued.

Join others who value a workplace for all. We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders.

We’re dedicated to serving Rhode Islanders. Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state—building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults.

Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer.

Why this job matters: Investigate and resolve member and provider complaints, benefits appeals and administrative appeals on all company products. Ensure compliance with state and federal guidelines, including Centers for Medicare and Medicaid Services requirements. Maintain all appeals documentation according to external agency requirements.

What you will do

• Investigate and resolve member and provider complaints, benefits appeals, and administrative appeals for all company products.
• Maintain documentation of cases.
• Respond to internal and external inquiries, assist with special member cases, and suggest resolutions via telephone or written communication.
• Assist members gain a better understanding of the plan through education.
• Identify potential quality of care issues; elevate as appropriate.
• Collaborate with internal areas to perform trend analysis; identify reasons for appeals and determine if a review of corporate policies, procedures, or product design is necessary.
• Participate in departmental audits in preparation of regulatory site visits.
• Participate in department initiatives and projects.
• Perform other duties as assigned.

What you need to succeed

• High school degree
• Two to four years experience in a managed care environment
• Knowledge of health insurance laws and regulations
• Working knowledge of Microsoft Office including Excel, and Word
• General computer proficiency
• Written and verbal communications skills
• Good organization skills
• Time management skills
• Detail oriented
• Ability to research and organize data
• Ability to organize work efficiently to meet established time and quality standards

The extras

• Proficiency with Microsoft Suite of products; i.e., Word, Excel, PPT, etc
• Prior health insurance industry experience (Customer service, Claims, Systems)

Location: BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal.

We actively support associate well‑being and work/life balance and offer the following schedules, based on role:

• In-office: onsite 5 days per week
• Hybrid: onsite 2-4 days per week
• Remote: onsite 0-1 days per week

Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia

BCBSRI is an equal opportunity employer.

The law requires an employer to post notices describing the Federal laws. Please visit www.eeoc.gov/know-your-rights-workplace-discrimination-illegal to view the "Know Your Rights" poster.