Grievance Appeals Coordinator I

In this role as a Medicare Appeals Coordinator, you will take ownership of retrospective authorization appeals and high-priority escalated cases. You will dive into complex claims histories, collaborate closely with Clinical, Intake/Triage, and operational partners, and navigate multi-system environments to drive fair, audit-ready, and compliant outcomes. The ideal candidate brings a sharp eye for detail, sound judgment under tight deadlines, and a proven track record in Medicare grievance and appeals processing. If you are an organized self-starter who excels at balancing competing priorities and solving complex operational puzzles, you will fit right in with our high-performing team. Key Responsibilities: Investigate, review, and resolve retrospective authorization appeals and escalated Medicare cases in strict accordance with regulatory guidelines. Research clinical documentation, authorization files, and claims history across multiple internal systems to determine compliant case resolutions. Partner cross-functionally with Clinical, Intake/Triage, Claims, and leadership teams to coordinate case outcomes and mitigate operational risks. Maintain audit-ready documentation and track daily inventory to ensure zero aging cases and strict turnaround-time compliance. Identify operational bottlenecks, escalate processing risks proactively, and champion continuous process improvements. Qualifications & Critical Skills: 2+ years of Grievance and Appeals experience within healthcare or managed care. Proven expertise in Medicare appeals regulations, case processing, and turnaround times. analytical research, critical thinking, and independent decision-making capabilities. Demonstrated ability to manage high-volume inventories and prioritize competing deadlines. Proficient in navigating complex, multi-screen database systems in a remote setting. Excellent written and verbal communication skills; dedicated home office setup.

salary: $22.46 - $22.47 per hour shift: First work hours: 8 AM - 5 PM education: High School

Responsibilities

Investigate, review, and resolve retrospective authorization appeals and escalated Medicare cases in strict accordance with regulatory guidelines. Research clinical documentation, authorization files, and claims history across multiple internal systems to determine compliant case resolutions. Partner cross-functionally with Clinical, Intake/Triage, Claims, and leadership teams to coordinate case outcomes and mitigate operational risks. Maintain audit-ready documentation and track daily inventory to ensure zero aging cases and strict turnaround-time compliance. Identify operational bottlenecks, escalate processing risks proactively, and champion continuous process improvements.

Skills

• Medicare Appeals
• Analytical Research
• Inventory Management

Qualifications

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

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.

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 HRsupport@randstadusa.com.

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.