Weekend Appeals & Grievances Inventory Lead

Healthfirst; New Jersey; On-site; USD 89,000 - 149,000; Full time

Benefits offered by this job

Health insurance

Dental coverage

Vision coverage

401k contributions

Job summary

Healthfirst seeks a Weekend Inventory Manager for the Appeals & Grievances team to oversee weekend staffing, volume planning and compliant routing of appeals. This full-time role requires coordinating with Medical Peer reviewers, vendors and other departments to ensure timely processing and high-quality output.

The ideal candidate has a background in appeals or healthcare, strong written and verbal communication, and the ability to work independently in a fast-paced environment with weekend

Qualifications

• High school diploma or GED.
• Experience in appeals and grievances or healthcare environment.
• Ability to communicate verbally and in writing.
• Experience working independently in a fast-paced environment with multiple priorities.
• Willing to work weekend schedule (Fri-Mon or Thurs-Sun).
• Experience with Word, Excel, corporate email and filing systems; familiarity with care management systems such as CCMS, TruCare and Hyland.

Responsibilities

• Prepare and plan weekend staff assignments and volume to ensure compliance.
• Triage and assign expedited appeals and optimize routing.
• Manage inventory to maintain compliance for weekend appeals.
• Coordinate with vendors and outside departments for escalation and collaboration.
• Review case changes, cancellations and Level 2 appeals submissions.
• Maintain HIPAA confidentiality and adherence to regulatory guidelines.

Skills

Verbal and written communication

Education

H.S. Diploma or GED

Bachelor's degree

Tools

CCMS

TruCare

Hyland

Microsoft Word

Microsoft Excel

Job description

Healthfirst seeks a Weekend Inventory Manager for the Appeals & Grievances team to oversee weekend staffing, volume planning and compliant routing of appeals. This full-time role requires coordinating with Medical Peer reviewers, vendors and other departments to ensure timely processing and high-quality output.

The ideal candidate has a background in appeals or healthcare, strong written and verbal communication, and the ability to work independently in a fast-paced environment with weekend