Grievance Specialist

Accountabilities • Maintain current knowledge of healthcare products, benefits, policies, procedures, and applicable grievance requirements.

• Conduct thorough grievance investigations by reviewing case details, member records, policies, procedures, and other relevant information to identify root causes. • Triage and categorize grievances accurately, ensuring cases are routed appropriately and handled according to established processes. • Communicate with members by telephone and written correspondence, providing clear, professional, and empathetic support while meeting regulatory requirements. • Document investigations, decisions, communications, and case activity accurately across multiple systems. • Ensure grievances are resolved within applicable regulatory and departmental timelines. • Collaborate with internal stakeholders to gather information, investigate concerns, and develop complete and appropriate resolutions. • Escalate complex cases when additional expertise or support is required and help facilitate timely resolution. • Identify recurring grievance themes, operational issues, and member-experience opportunities that can inform process improvements. • Contribute to a culture of continuous learning, member advocacy, accuracy, and regulatory compliance.

Requirements

• Demonstrated experience handling Medicare Advantage appeals and grievances ; Medicare experience is required. • Bachelor’s degree or equivalent relevant experience in healthcare, conflict resolution, or a related field preferred. • Working knowledge of healthcare insurance products, policies, procedures, and claims processes. • Strong investigative, analytical, and problem-solving abilities, with the capacity to assess complex case information and determine appropriate next steps. • Exceptional attention to detail and a strong commitment to documentation and data accuracy. • Excellent written and verbal communication skills, including the ability to explain complex information clearly and concisely. • Strong customer service and conflict-resolution skills, particularly when supporting members who may be frustrated, concerned, or vulnerable. • Strong organizational and time-management skills, with the ability to manage multiple cases and consistently meet deadlines. • Experience escalating cases and collaborating effectively with internal stakeholders across different functions. • Strong computer and documentation skills, with the ability to work confidently across multiple platforms and systems. • Adaptability and resilience when regulations, priorities, workloads, or case volumes change. • Ability to work independently while contributing effectively within a collaborative team environment.

Benefits

• Remote work within the United States. • Hourly salary range of $23–$26 , with actual compensation based on qualifications, relevant experience, skills, education, certifications, and location. • Employer-sponsored medical, dental, and vision coverage , with low- or no-premium options. • Generous paid time off. • $100 monthly mobile or internet stipend . • Stock options available to employees. • Bonus eligibility for applicable roles. • 401(k) retirement program. • Parental leave program. • Employee-focused healthcare and wellness benefits. • Additional total-rewards offerings for eligible full-time employees.