Grievance and Appeals Coordinator

Solis Health Plans

2d

About The Position

The Grievance and Appeals Coordinator is responsible for the receipt, review, and triage of incoming correspondence related to member and provider grievances and appeals. This role focuses exclusively on intake functions, including mail handling, case creation, and accurate classification of cases within the system. The coordinator ensures all submissions are properly documented and routed in compliance with CMS, NCQA, and AHCA guidelines. This position does not perform case investigation or resolution.

Requirements

• High school diploma or equivalent required; associate or bachelor’s degree preferred.
• Minimum of 1–3 years of experience in healthcare administration, managed care, claims, or intake processing.
• Experience with mailroom operations, data entry, or case intake preferred.
• Basic understanding of healthcare claims and denial terminology.
• Familiarity with CMS, NCQA, and AHCA guidelines related to grievances and appeals intake.
• Strong data entry skills with high attention to detail and accuracy.
• Ability to review and interpret documents quickly and accurately.
• Strong organizational and time management skills.
• Ability to meet strict turnaround and logging deadlines.
• Proficiency in case management systems and standard office software.

Nice To Haves

• Experience in a Medicare or Medicaid managed care environment.
• Prior intake or document processing experience in a regulated healthcare setting.

Responsibilities

• Mail Intake & Correspondence Handling
• Case Creation & Data Entry
• Triage & Classification
• Regulatory Compliance
• Claims & Denial Awareness
• Quality & Documentation
• Collaboration

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED