Jobs in the United States

25+ jobs

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Added 2 mins ago
TC
Assistant Client Relations Manager
Tidewater Consulting
Smyrna, GA
- $60,000 to $70,000 USD / year
Tidewater looking for the best talent in the Atlanta area, to join our Client Relations team. The objective of the Client Relations role is to extend company outreach, establish new…
Added 2 mins ago
TC
Entry Level Campaign Manager
Tidewater Consulting
North Atlanta, GA
- $4,000 to $8,000 USD / month
…growth of our Southeast locations. Our Business Management Program will help you build valuable professional and leadership skills to thrive in your…
Added 2 mins ago
TC
Campaign Manager Trainee
Tidewater Consulting
North Atlanta, GA
- $62,000 to $72,000 USD / year
…growth of our Southeast locations. Our Business Management Program will help you build valuable professional and leadership skills to thrive in your…
Added 2 mins ago
TC
Assistant Client Relations Manager
Tidewater Consulting
Atlanta, GA
- $60,000 to $70,000 USD / year
…As we expand our Southeast Division, the objective of this Client Relations role is to extend company outreach, establish new business, and drive revenue on behalf of our…
Added 2 mins ago
TC
Account Manager - Client Relations
Tidewater Consulting
Alpharetta, GA
- $60,000 to $70,000 USD / year
…growth of our Southeast locations. Our Business Management Program will help you build valuable professional and leadership skills to thrive in your…
Added 31 mins ago
BC
Program Manager
Brilliant Corners
Remote, United States
- $83,000 to $93,000 USD / year
…community-based housing has on individual health and well-being, the Program Manager brings a creative, solutions-oriented, and flexible approach to complex operational challenges. The…
Added 31 mins ago
BC
Temporary Housing Acquisitions Specialist
Brilliant Corners
Remote, United States
- $57,999 USD / year
…implement creative and supportive housing solutions tailored to our client’s individual circumstances. We are a key community partner in solving the housing crisis in the San Francisco…
Added 31 mins ago
BC
PSH PBV Case Manager
Brilliant Corners
Gardena, CA
- $52,998 USD / year
The Case Manager, Permanent Supportive Housing Project Based (PSH-PB) will provide intensive case management services to a caseload of up to 20 homeless individuals who are eligible for…
Added 31 mins ago
BC
Temporary Program Associate
Brilliant Corners
Remote, United States
- $54,995 USD / year
The Program Associate provides critical support to the Housing Services team through administrative back-office functions, keeping up-to-date records, preparing check requests, updating…
Added 31 mins ago
BC
PBV PSH Case Manager
Brilliant Corners
Historic Filipinotown, CA
- $52,998 USD / year
The Case Manager, Permanent Supportive Housing Project Based (PSH-PB) will provide intensive case management services to a caseload of up to 20 homeless individuals who are eligible for…
Added 33 mins ago
Commercial Portfolio Manager - To 140K - Houston, TX - Job 3671B
The Symicor Group
Houston, TX
Our bank client is seeking to fill a Commercial Portfolio Manager role in the Houston, TX area. The position is responsible for supporting the Bank’s portfolio of business by servicing…
Added 33 mins ago
Commercial Portfolio Manager - To 120K - Waukesha, WI - Job 3744
The Symicor Group
Waukesha, WI
Our bank client is seeking to fill a Commercial Portfolio Manager role in the Waukesha, WI area. The position is responsible for supporting the Bank’s portfolio of business by servicing…
Added 33 mins ago
Branch Manager - To 73K - Rossville, TN - Job 3801-17719
The Symicor Group
Rossville, TN
Our client is seeking to fill a Branch Manager role in the Rossville, TN market. The successful candidate will be responsible for managing branch activities, including teller operations,…
Added 33 mins ago
BSA Compliance Officer - To 105K - Ontario, CA - Job 3758
The Symicor Group
Ontario, CA
Our bank client is seeking to fill a BSA Compliance Officer role in the Ontario, CA area. This selected candidate will be responsible for providing support to the BSA Compliance Manager on…
Added 33 mins ago
Commercial Portfolio Manager - To 120K - Greenfield, WI - Job 3763
The Symicor Group
Greenfield, WI
Our bank client is seeking to fill a Commercial Portfolio Manager role in the Greenfield, WI area. The position is responsible for supporting the Bank’s portfolio of business by servicing…
Added 33 mins ago
Branch Manager - To 75K - Orland Park, IL - Job 3846-146965
The Symicor Group
Orland Park, IL
Our client is seeking to fill a Branch Manager role in the Orland Park, IL market. The successful candidate will be responsible for managing branch activities, including teller operations,…
Added 33 mins ago
BSA Officer - To 90K - Chicago Ridge, IL - Job 3813-6103
The Symicor Group
Chicago Ridge, IL
Our bank client is seeking to fill a BSA Officer role in the Chicago Ridge, IL area. This selected candidate will be responsible for providing support to the BSA Compliance Manager on…
Added 33 mins ago
TS
Manager of Mortgage Lending - To 125K - Rockford, IL - Job 3856-5035
The Symicor Group
Rockford, IL
- Up to $125,000 USD / year
Our bank client is seeking to fill a Manager of Mortgage Lending role in the Rockford, IL area. The position is responsible for providing strategic leadership and operational oversight for…
Added 33 mins ago
TS
Branch Manager - To 60K - Rockford, IL - Job 3857-5035
The Symicor Group
Rockford, IL
- Up to $60,000 USD / year
Our client is seeking to fill a Branch Manager role in the Rockford, IL market. The successful candidate will be responsible for managing branch activities, including teller operations,…
Added 33 mins ago
VP Commercial Portfolio Manager - To 215K - Glencoe, IL - Job # 3719
The Symicor Group
Glencoe, IL
Our bank client is seeking to fill a VP Commercial Portfolio Manager role in the Glencoe, IL area. The position is responsible for supporting the Bank’s portfolio of business by servicing…
Added 33 mins ago
TS
Deposit Operations Specialist - To 25/hr - Crystal Lake, IL - Job 3862-6411
The Symicor Group
Crystal Lake, IL
- $25 USD / hour
Our bank client is seeking to fill a Deposit Operations Specialist role to be based in the Crystal Lake, IL market. The successful candidate will be processing all deposit…
Added 34 mins ago
Temp- Housing Supports Program Case Manager
Bright Harbor Healthcare
Berkeley Township, NJ
The Housing Supports Program (HSP) offers a supportive housing service aimed at helping individuals secure safe and stable housing, as well as providing assistance in maintaining a stable…
Added 34 mins ago
BH
Case Manager
Bright Harbor Healthcare
Toms River, NJ
- $38,000 to $42,000 USD / year
Maintain timely, accurate documentation of client contacts, interventions, progress, and treatment activities in accordance with program requirements.
Added 57 mins ago
Manager-Sr. Manager- Tax and or Audit
Brady Martz
Remote, United States
…supervision of Senior Managers, depending on the nature of the client engagement. This role requires strong communication, organizational, and leadership skills to successfully manage…
Added 57 mins ago
Manager-Sr. Manager- Tax and or Audit
Brady Martz
Remote, United States
…supervision of Senior Managers, depending on the nature of the client engagement. This role requires strong communication, organizational, and leadership skills to successfully manage…

GuideWell

Appeals & Grievances Coordinator

FL, United States

$20 to $33 USD / hour

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Job details

Pay: $20 to $33 USD / hour
Experience: 3+ years related work experience in experience in Member Contact, Enrollment, Maintenance and Billing (EM&B), Claims or Medicare experience.
Posting language: English
Posted: Nov 4, 2026

Original job description

We seek contributors who deliver results with accountability while collaborating seamlessly across boundaries. They embrace change with resilience, staying curious and learning continuously in a rapidly evolving landscape. Grounded in business understanding and comfortable with AI and digital tools, they solve problems with critical thinking and creativity. Above all, they are driven to serve - ensuring their work creates meaningful impact for members and the community we support.

The primary responsibilities of a Medicare Appeals and Grievances Coordinator are centered on daily resolution of Medicare member, member's representatives (which can be a treating physician) and non-participating provider's appeals and grievances in compliance with applicable CMS timeframes and regulations. The Medicare Appeals & Grievances Coordinator is accountable for inventory prioritization of case load to meet various CMS and OIR required SLAs, gathering applicable information related to the case, working with appellants and delegated vendors to obtain for medical records, tracking effectuations, and meeting strict written and oral notification requirements.

What You Will Be Doing

Review appeal and grievance cases from various appellant types (member, member representative, treating physician and non-participating providers) in accordance with CMS regulatory guidelines and timeframes.
Must ensure cases are classified correctly and reviewed for potential expedited requests.
Resolves complex standard or expedited grievances, appeals or disputes involving expressions of dissatisfaction, reimbursement, medical necessity,
Utilization Management and benefits from the various appellant types (member, member representative, treating physician and non-participating providers) in accordance with CMS regulatory guidelines and timeframes.
Prioritize case workload to ensure CMS timeframes and required written notifications are met for various case types:
Standard Pre-Service Appeals
Expedited Pre- Service Appeals
Post Service appeals
Payment Disputes
MA Grievances
Med Supp Grievances
Access various systems such as: MAAGC, JIVA, Diamond, ProviderConnect, Client Letter, ERCMS RADMD, Magellan, and Blue 2 in order to gather pertinent data related to the case and document resolution.
Conduct a thorough research and accurately document pertinent details to include research details, action taken for resolution or outreach to various business partners and attach supporting documents to the case
Coordinates with internal business partners and provides case details, gathers required data or medical records for cases related to clinical decisions, delegated vendors, claims, network, etc.
Ensure proper research is completed with documentation of supporting details to render a final determination with verbal and/or written notification to the appellant within the CMS timeframes
Perform outreach to members, providers, internal and external business partners in order to complete resolution of appeal or grievance
Facilitates escalated calls and issues from providers and/or members regarding appeals or dispute decisions. Escalates any issues or phone calls to the Manager as needed.

What We Require

3+ years related work experience in experience in Member Contact, Enrollment, Maintenance and Billing (EM&B), Claims or Medicare experience. High school diploma or GED
Additional Required Qualifications
Experience using Siebel, Diamond, JIVA and other Medicare databases.
Ability to work flexible schedule with overtime and weekends when needed
Medicare product knowledge
Ability to work independently and collaboratively as a team member
Excellent interpersonal skills and an ability to recognize, understand, and respond to sensitive member issues or concerns
Ability to manage multiple priorities, have analytical and problem solving skills with attention to detail

What We Prefer

Bachelor’s degree
Strong working knowledge of Medicare Advantage/ Supplement/ Frozen Products, CMS, OIR, DFS and other regulatory requirements
Proven organizational skills with strong attention to detail
Proven ability to work independently, collaboratively and use appropriate judgment to make independent decisions by following guidelines Intermediate PC skills (MS Word, Excel, PowerPoint) Hands-on experience processing Medicare Claims, Written Inquiries or EMB transactions
Current Experience with JIVA, Diamond, ProviderConnect, CustomerConnectClient Letter, ERCMS RADMD, Magellan, and Blue 2

General Physical Demands

Exerting up to 10 pounds of force occasionally to move objects.
Jobs are sedentary if traversing activities are required only occasionally.
Team schedules are determined based on role requirements and business needs. Travel to and from our corporate offices may be required.

What We Offer

As a Florida Blue employee, you will be at the heart of GuideWell’s vision – to lead the nation in transforming health through compassionate, connected, and technology-enabled care that delivers personalized value and empowered living.

To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:

Medical, dental, vision, life and global travel health insurance
Income protection benefits: life insurance, short- and long-term disability programs
Leave programs to support personal circumstances
Retirement Savings Plan including employer match
Paid time off, volunteer time off, 10 holidays and 2 well-being days
Additional voluntary benefits available; and a comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.

To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases. Typical Hourly Offer/Pay Range: $20 - $25

Hourly Pay Range: $20 - $33

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.

We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.

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More about this job

Skills

Critical thinking
CMS
Research
Documentation
Product knowledge
Work independently
Interpersonal skills
Problem solving
Attention to detail
Organizational skills
Microsoft Word
Microsoft Excel
Microsoft PowerPoint

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