Grievance & Appeals Claims Specialist - Denver Health Medical Plan (Must Live in Colorado. Weekly On Site Requirement.)

Denver Health•Denver, CO

5d•$24 - $34•Hybrid

About The Position

The Grievance & Appeals Claims Specialist handles and resolves client grievances and appeals concerning services and claims. The role ensures complaints are addressed promptly and accurately in accordance with regulatory standards and organizational policies, advocates for clients, and works to improve satisfaction while safeguarding organizational integrity and efficiency. This is a hybrid position in Denver, Colorado. Applicants must live in Colorado and work in the office two days per week. The position works day shifts and offers a salary of $24.10–$33.74 per hour.

Requirements

High school diploma or GED.
Either an associate degree and one year of claims, customer service, or grievance and appeals experience; or three years of insurance-industry experience, preferably in claims; or one year of QNXT experience.
Strong knowledge of regulatory requirements and insurance products.
Excellent communication and interpersonal skills, including strong written and verbal communication.
Analytical and problem-solving abilities.
Ability to appropriately handle sensitive and confidential information.
Proficiency with relevant software and database systems.
Strong organizational and time-management skills.
Understanding of grievance and appeals processes.
Attention to detail and accuracy.
Ability to work independently and as part of a team.
Ability to manage multiple tasks and meet deadlines.
Must live in Colorado and work in the Denver office two days per week.

Nice To Haves

Associate degree preferred.
Claims experience preferred for applicants qualifying through insurance-industry experience.

Responsibilities

Handle and resolve incoming grievances and appeals in a timely and efficient manner.
Accurately document complaints, appeals, and resolutions in the system.
Conduct investigations and gather information needed to resolve appeals.
Communicate with clients, providers, and internal departments to resolve issues.
Ensure compliance with regulatory standards and organizational policies.
Collaborate with other departments to address systemic issues and prevent future grievances.
Provide management with regular updates on grievance and appeal status.
Analyze trends in claims grievances and appeals to identify areas for improvement.

Benefits

Paid time off starting at 28 days per year, inclusive of vacation, personal/sick time, and seven holidays.
Fully paid parental leave for up to six weeks.
Retirement plans with immediate eligibility and employer contributions up to 9.5%.
Medical, dental, and vision plans.
Employer-paid disability and life insurance.
Well-being programs, including an on-site employee fitness center and the RESTORE Center.
Free RTD EcoPass for public transportation.
Childcare discount programs.
Discounts and perks on large brands, travel, and more.
Tuition reimbursement and assistance.
Education, coaching, and professional development opportunities through the Workforce Development Center.
Career advancement pathways and professional clinical advancement program.
Shared governance opportunities.
Public Service Loan Forgiveness-eligible employer, with free student loan coaching and assistance navigating the program.
National Health Service Corps and Colorado Health Service Corps eligibility.