Specialist, Admin Complaints, Grievances & Appeals - Remote

Overview

As a Specialist in Admin Complaints, Grievances & Appeals, you will manage and resolve complex administrative issues for members and providers, ensuring compliance with regulatory standards and enhancing member satisfaction.

In Short

• Manage and resolve grievances and appeals for members and providers.
• Act as a subject matter expert on non-clinical case resolution.
• Conduct investigations and analyze internal data for case resolution.
• Collaborate with internal departments for comprehensive case management.
• Draft accurate resolution letters and maintain case files.
• Monitor case timelines to meet regulatory deadlines.
• Ensure compliance with all applicable laws and regulations.
• Work remotely, with occasional travel for team meetings.
• 1+ years of experience in a regulated industry preferred.
• Hourly pay rate of $22.00 with eligibility for benefits.

Requirements

• 1+ years of professional experience in healthcare or insurance.
• Experience managing escalated customer or member cases.
• Ability to draft formal written communications.
• Experience working in a structured, workflow-driven environment.
• Bachelor's degree is a plus.

Benefits

• Medical, dental, and vision benefits.
• 15 days of paid vacation per year.
• 401(k) plan participation.
• Paid sick time and parental leave.
• Paid wellness time and reimbursements.