Grievance and Appeals Coordinator

Grievance & Appeals Coordinator I

Contract Type / Duration: 6-Month Contract | Potential Extension or Conversion
Location: Remote Ohio (Columbus area)
Training: Training may take place at an office in Columbus
Work Hours: Monday Friday | 8:00 AM 5:00 PM | 1-hour lunch
Pay Rate: $23

Job Summary

We are seeking a Grievance & Appeals Coordinator I to support the review and resolution of member grievances, provider disputes, and claims and authorization appeals. This role is responsible for gathering and analyzing information, preparing correspondence, maintaining case documentation, and ensuring appeals and grievances are processed accurately and within required timelines.

This is a high-volume production role where work is assigned through a queue and requires strong organization, attention to detail, accountability, and the ability to adapt to changing priorities.

The position offers an opportunity to work closely with clinical coordinators, medical directors, case managers, and claims professionals while gaining valuable experience in healthcare operations, Medicaid, Medicare, Marketplace programs, and regulatory requirements.

Key Responsibilities

• Review and process verbal and written member grievances, provider complaints, disputes, and appeals.

• Gather, analyze, and document information needed to resolve cases.

• Prepare response letters for members and providers.

• Maintain accurate files and documentation for individual appeals and grievances.

• Support grievance and appeals committee activities as needed.

• Assist with pay-for-performance programs, including data entry, tracking, research, and organization.

• Support HEDIS-related activities, including data entry, provider outreach, and claims research.

• Process and manage high volumes of documents, including scanning, copying, faxing, and incoming mail.

• Work from a production queue with a strong focus on accuracy, aging, and timely completion.

• Communicate effectively with team members through email and Microsoft Teams.

Top Required Skills

1. Strong organization and time management Ability to meet deadlines and manage high-volume work in a fast-paced, compliance-driven environment.

2. Healthcare/managed care knowledge Familiarity with Medicaid, Medicare, Marketplace, grievances, appeals, claims, or related healthcare operations.

3. Microsoft Office proficiency Experience using Word, Excel, Teams, Outlook, and SharePoint.

Preferred Skills / Experience

• 2+ years of experience with grievances and appeals, claims, managed care, or a related healthcare environment.

• Experience working with Medicaid, DSNP-Medicare, and/or Marketplace programs.

• Strong written, verbal, analytical, and problem-solving skills.

• Experience working in a production or queue-based environment.

• Ability to manage multiple priorities while maintaining accuracy and timeliness.

Education

Required: High school diploma or equivalent

Preferred: Associate's degree

Certifications

None required.

What Makes This Opportunity Stand Out

This role provides hands-on experience in healthcare operations and the opportunity to work across multiple functions, including clinical, claims, case management, and medical leadership. The work directly supports the resolution of member and provider concerns and offers exposure to healthcare regulations, state contracts, quality requirements, and internal healthcare systems.

Equal Opportunity Statement

The client is an equal opportunity employer. Employment decisions are made without regard to race, color, religion, sex, gender identity, pregnancy, national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, military service, or any other non-merit-based factor.