Grievance Appeals Coordinator I

In this role, you will investigate, evaluate, and resolve complex Medicare member and provider appeals and grievances while navigating regulatory guidelines. Working in a fast-paced setting, you will serve as a vital link between providers, members, and internal committees to ensure every case is handled with accuracy, fairness, and attention to detail. The ideal candidate brings a logical, calm problem-solving mindset, outstanding organizational skills, and a proven background in managed care appeals. You will thrive within a supportive culture that values analytical expertise, rewards initiative, and provides the resources needed to succeed. Key Responsibilities: • Review, investigate, and resolve verbal and written Medicare member and provider appeals and grievances within strict regulatory deadlines. • Evaluate incoming appeal requests to determine appropriate categorization and action plans. • Prepare, review, and validate response letters for accuracy regarding patient/provider demographics and service details. • Compile, organize, and submit comprehensive appeals documentation to C2C in required formats. • Monitor and track appeal timelines proactively to eliminate backlogs and prevent compliance delays. • Support departmental reporting, Grievance and Appeals Committee functions, and HEDIS initiatives. Qualifications & Skills: • 2+ years of grievance, appeals, or claims experience in a managed care or healthcare environment (required). • High school diploma or equivalent required; Associate degree preferred. • working knowledge of healthcare appeals processes, Medicare standards, and documentation guidelines. • Exceptional organizational, prioritization, and time management skills in a fast-paced setting. • Demonstrated problem-solving ability, high attention to detail, and excellent written and verbal communication skills.

salary: $22.53 - $22.54 per hour shift: First work hours: 8 AM - 5 PM education: High School

Responsibilities

• Review, investigate, and resolve verbal and written Medicare member and provider appeals and grievances within strict regulatory deadlines.
• Evaluate incoming appeal requests to determine appropriate categorization and action plans.
• Prepare, review, and validate response letters for accuracy regarding patient/provider demographics and service details.
• Compile, organize, and submit comprehensive appeals documentation to C2C in required formats.
• Monitor and track appeal timelines proactively to eliminate backlogs and prevent compliance delays.
• Support departmental reporting, Grievance and Appeals Committee functions, and HEDIS initiatives.

Skills

• time management
• appeals process
• work independently

Qualifications

• Years of experience: 0 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 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.