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.

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