Grievance Appeals Coordinator I

Position Summary We are seeking a detail-oriented professional to analyze and resolve verbal and written claims and authorization appeals from providers, as well as pursue the resolution of formal grievances from members. You will be joining a highly collaborative team dedicated to closely supporting our member and provider populations. Key Responsibilities Case Management: Gather, analyze, and report on verbal and written complaints, grievances, and appeals from both members and providers. Documentation & Correspondence: Draft and prepare accurate acknowledgment and response letters for member and provider complaints, grievances, and appeals. Workflow Coordination: Build authorizations for medical review and coordinate the closure process, ensuring final communications are sent to the appropriate parties. Records Administration: Maintain organized and accurate files on individual appeals and grievances. Document Management: Manage large volumes of documentation, including copying, faxing, and scanning incoming mail. Prior Authorizations: Process and work efficiently with prior authorization requests. Performance: Meet or exceed established monthly departmental metrics for intake processing and quality. Qualifications & Experience Education: High school diploma or equivalent required; Associate’s degree preferred. Experience: 2+ years of experience in grievances, appeals, claims, Medicaid, or related healthcare administration/managed care environments. Technical Skills: Proficiency in Microsoft Office Suite (Outlook, Word, Excel). Soft Skills: oral and written communication skills, combined with excellent problem-solving abilities and the capacity to handle high-volume workflows efficiently.

salary: $22.99 - $23 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School

Responsibilities

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 grievance
Manage large volumes of documents including copying, faxing and scanning incoming mail.

Skills

• Processing Member appeals
• Prior authorizations
• Microsoft Office

Qualifications

• Years of experience: 2 years
• Experience level: Experienced

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Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact [email protected].

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.