Appeals and Grievance Specialist - Work from Home

Sagility

1d•$18•Remote

About The Position

BroadPath, a Sagility Company, is hiring experienced Appeals and Grievance Specialists to join our remote team! The Appeals and Grievance Specialist reviews, investigates, and resolves complaints, grievances, and appeals submitted by members and providers. This role serves as a key point of contact throughout the resolution process while ensuring cases are handled accurately, thoroughly, and in compliance with applicable requirements. Schedules, pay rates, and program details may vary based on business needs and client assignment. At BroadPath, a Sagility Company, we believe that transparency, authenticity, and collaboration are the keys to building strong, connected remote teams. Being on camera is an integral part of our culture. It is how we build relationships, share ideas, and stay engaged. If you value open communication, connection, and teamwork, you will thrive in our environment, where showing up authentically matters. What to Expect: On-camera participation during interviews, training, team meetings, and regular check-ins. Face-to-face discussions sparking collaboration and engagement A supportive atmosphere where you can express yourself openly and be part of a team that values your contributions. Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

Requirements

1+ year of Medicare Appeals and Grievance or Medicare Claims experience required
Familiarity with Windows based computer systems and the ability to learn new applications
Strong technical and keyboarding skills
Excellent verbal and written communication skills
Ability to stay focused and productive in repetitive task-based work
High School Diploma or equivalent

Nice To Haves

Experience with Medicare Part C or Part D preferred

Responsibilities

Manage and resolve complaints, grievances, and appeals from members and providers
Serve as the primary contact throughout the investigation and resolution process
Send acknowledgments and provide clear education on the grievance and appeal process
Gather relevant information and research case details to determine an appropriate resolution
Conduct fair, accurate, and timely case investigations
Communicate resolutions to appropriate internal and external parties
Ensure all required documentation is completed and maintained
Follow established policies, procedures, and regulatory requirements
Maintain productivity and quality standards in a structured workflow environment