Grievance Appeals Coordinator I

Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. Education/Experience: High school diploma or equivalent. Associate’s degree preferred. 2+ years grievance or appeals, claims or related managed care experience. oral, written, and problem solving skills. • Gather, analyze and report verbal and written member and provider complaints, grievances and appeals • Prepare response letters for member and provider complaints, grievances and appeals • Maintain files on individual appeals and grievances • May coordinate the Grievance and Appeals Committee • Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information • Assist with HEDIS production functions including data entry, calls to provider’s offices, and claims research. • Manage large volumes of documents including copying, faxing and scanning incoming mail Candidates for this role will be joining a tight-knit team of Clinical Coordinators (licensed nurses) and Appeals & Grievances Coordinators (non-clinical professionals), the team works closely with Medical Directors, Case Managers, and Claims experts, creating a rich environment for learning and cross-functional engagement. They’ll be reviewing member appeals, grievances, and provider disputes. The work is deeply impactful, as it directly affects the lives of Medicaid members. They will gain hands-on experience with state contracts, NCQA guidelines, and internal systems that are foundational to healthcare operations. Our motto, “The only thing consistent in HealthCare is Change” is more than a saying. It’s a mindset. We embrace change with resilience and readiness, supporting each other through shifting regulations, evolving member needs, and new business lines like DSNP-Medicare and Marketplace. Must have: oral, written, and problem-solving skills. Nice to haves: 2+ years grievance Skills Meeting deadlines in a fast-paced, compliance-driven environment Familiarity with Medicaid, DSNP-Medicare, and/or Marketplace Skilled use of Microsoft Office platforms (Word, Excel, Teams, Outlook, SharePoint)
salary: $22.85 - $22.86 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School
Responsibilities
• Gather, analyze and report verbal and written member and provider complaints, grievances and appeals
• Prepare response letters for member and provider complaints, grievances and appeals
• Maintain files on individual appeals and grievances
• May coordinate the Grievance and Appeals Committee
• Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information
• Assist with HEDIS production functions including data entry, calls to provider’s offices, and claims research.
• Manage large volumes of documents including copying, faxing and scanning incoming mail
Skills
- verbal and written
- grievances and appeals
- provider complaints
Qualifications
- Years of experience: 2 years
- Experience level: Experienced
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At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.
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