BusinessOperations - Grievance & Appeals Coordinator I - 210056

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. Strong 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

EEO:

Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.

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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. Strong 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
Story Behind the Need Business Group & Key Projects
Health plan or business unit Team culture Surrounding team & key projects Purpose of this team Reason for the request Motivators for this need Any additional upcoming hiring needs?		We anticipate decreased staffing in the upcoming months and an increase of inventory, as a result we need assistance to maintain the operations of our department. The team reviews provider disputes, member grievances and appeals with high focus on timeliness. We currently have several employees in equivalent roles that are readily available to field questions and motivate one another. The department is also being assessed for proper staffing needs and may find opportunities for FTE employment in 2027.
Typical Day in the Role
Daily schedule & OT expectations Typical task breakdown and rhythm Interaction level with team Work environment description		The daily schedule is 8:00 5:00 with a 1-hour lunch to be taken between 11:00 and 1:00 M-F This is a production role; work will be provided through a queue using the Prime system with high focus on aging and timeliness. Behavior and accountability and ability to pivot when new priorities come up) Emails and Team chats to ensure communication is reached and assistance is available, if needed
Compelling Story & Candidate Value Proposition
What makes this role interesting? Points about team culture Competitive market comparison Unique selling points Value added or experience gained		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.
Candidate Requirements
Education/Certification	Required: High School Diploma			Preferred: Associate s degree preferred
Licensure	Required:			Preferred:
Years of experience required Disqualifiers Best vs. average Performance indicators		Must have: Strong oral, written, and problem-solving skills. Nice to haves: 2+ years grievance or appeals, claims or related managed care experience. Disqualifiers: Performance indicators:
Top 3 must-have hard skills Level of experience with each Stack-ranked by importance Candidate Review & Selection		1	Meeting deadlines in a fast-paced, compliance-driven environment
		2	Familiarity with Medicaid, DSNP-Medicare, and/or Marketplace
		3	Skilled use of Microsoft Office platforms (Word, Excel, Teams, Outlook, SharePoint)