Job Description

STRATEGIC STAFFING SOLUTIONS HAS AN OPENING!

This is a Contract Opportunity with our company that MUST be worked on a W2 Only. No C2C eligibility for this position. Visa Sponsorship is Available! The details are below.

“Beware of scams. S3 never asks for money during its onboarding process.”

Job Title: Grievance & Appeals Coordinator
Contract Length: 6+ Months
REMOTE WORK

Job ref# 244102

Role Overview

We are seeking a detail-oriented and analytical person to support the timely and accurate resolution of member appeals and grievances. The analyst will be responsible for researching, evaluating, and responding to cases in compliance with regulatory and accreditation guidelines. This role requires strong writing, customer service, and investigative skills to ensure members receive clear, comprehensive, and compliant case determinations.

Key Responsibilities

• Process and resolve member appeals and grievances in accordance with all applicable state, federal, and accreditation requirements.
• Conduct thorough research and analysis of case documentation, contracts, and regulatory provisions to ensure accurate resolutions.
• Draft and deliver clear, professional written responses and letters summarizing case findings and determinations.
• Contact members or representatives to gather information, clarify concerns, and communicate case outcomes.
• Maintain detailed documentation and ensure timely completion of all case assignments.
• Collaborate with internal departments to collect data and resolve complex issues.
• Apply critical thinking and problem-solving to interpret data and evaluate outcomes in line with established procedures.

Top 3 Required Skills/Experience

1. Proven ability to handle high-volume workloads in a fast-paced environment with strong computer proficiency.
2. Working knowledge of insurance, Medicare, and CMS guidelines.
3. Demonstrated excellence in customer service and member communication.

Additional Required Skills/Experience

• Strong letter writing and documentation skills.
• Exceptional analytical and research abilities.
• Ability to multi-task effectively while maintaining accuracy and compliance.
• Familiarity with standard concepts, practices, and procedures related to claims analysis and regulatory evaluation.

Preferred Skills/Experience

• Previous Appeals and Grievances experience within a health insurance setting.
• Bachelor’s degree in Healthcare Administration, English, Communications, or a related field.
• Experience analyzing insurance claims and classifying cases (e.g., grievance vs. appeal vs. organizational determination).
• Strong project management and organizational skills.
• Proficiency with Microsoft Office applications (Excel, Word) and ability to navigate multiple computer systems.
• Basic technical literacy: saving PDFs, navigating spreadsheets, and adapting to new software tools.

Education & Certifications

• Required: High School Diploma or GED.
• Preferred: Bachelor’s Degree in English, Communications, Healthcare Administration, or a related discipline.