Healthcare Appeals and Grievances Coordinator {176643}

Title: Healthcare Appeals and Grievances Coordinator
Location: Remote in Ohio – Columbus; training may take place at the Easton office
Pay: $23.00 per hour
Schedule: Monday-Friday, 8:00 AM-5:00 PM
Employment Type: W2 6-Month Temp-to-hire Assignment with potential for extension or conversion to FTE based on business needs
Position Overview
This is a non-clinical healthcare role focused on reviewing and resolving member appeals, grievances, and provider disputes. You’ll manage cases through a queue using the Prime system, research case information, and ensure work is completed accurately and within required timelines. The position works closely with Clinical Coordinators, Medical Directors, Case Managers, and Claims professionals, with regular communication and collaboration across the team.
Responsibilities

• Review and process member appeals, grievances, and provider disputes
• Research case information and apply applicable guidelines, procedures, and requirements
• Manage assigned cases through the Prime system and maintain an appropriate pace of production
• Monitor aging cases and prioritize work based on required turnaround times
• Ensure cases are handled accurately and within established deadlines
• Communicate with team members through Microsoft Teams and email to ask questions, provide updates, and coordinate assistance when needed
• Collaborate with clinical, claims, and other healthcare professionals when additional information or assistance is needed
• Adjust to changing priorities and new business requirements while remaining accountable for assigned work
• Follow applicable state contract requirements, NCQA guidelines, and internal processes

Qualifications

• High School Diploma required, Associate's degree preferred
• 2+ years of experience in healthcare grievances, appeals, claims, managed care, or a related area required
• Familiarity with Medicaid, DSNP-Medicare, and/or Marketplace programs
• Comfortable working in a production environment where timeliness and case volume are closely monitored
• Proficiency with Microsoft Word, Excel, Teams, Outlook, and SharePoint