Job Description
Health Services Specialist I – Appeals & Grievances
Location: Onsite to start, Hybrid after training
Schedule: Monday – Friday, 8:30 AM – 5:00 PM (flexible by ~30–60 minutes)
About the Role
We are seeking a Health Services Specialist I to support the Managed Care Operations team. This role is ideal for someone who has experience in healthcare appeals and grievances (A&G) and is looking for an opportunity to grow with a well-respected organization.
This position will begin onsite for training (2–4 weeks) and then transition to hybrid :
- Initially 4 days onsite / 1 remote (or 3 in / 2 out)
- Potentially 2 days onsite / 3 remote once performance is established
There is a strong possibility of a Contract-to-Hire opportunity based on performance and volume needs.
Day-to-Day Responsibilities
- Review, document, and coordinate appeals and grievances from health plans.
- Manage assigned cases through SharePoint , ensuring deadlines are met.
- Conduct daily outreach calls to provider offices for coordination of best site of service for outpatient surgeries.
- Notify providers with new referrals when member eligibility status has changed.
- Track and document all activities accurately.
- Monitor the group grievance email and prioritize assignments based on due dates.
- Collaborate with team members to support case volume as needed.
- Assist with process improvements and support ongoing workflow initiatives.
Required Qualifications
- Minimum 2 years of experience in healthcare related to grievances, care coordination, or member services.
- Basic knowledge and understanding of Appeals & Grievances (A&G).
- Strong organizational skills with the ability to prioritize time-sensitive work.
- Proficient in Microsoft Office (Word, Excel, PowerPoint).
- Excellent verbal and written communication skills.
- Comfortable making and receiving provider calls daily.
Job Tags
Contract work, Work at office, Remote work, Monday to Friday, Flexible hours,