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Medicare Grievance Jobs (NOW HIRING)

AlohaCare

Pharmacy Technician

Honolulu, HI · On-site

$17.25 - $21/hr

... grievance requests, participate in the Medicare annual plan build implementation and testing, manage the Pharmacy help desk line, assist Customer Service on drug-related concerns/issues for the ...

AlohaCare

Pharmacy Technician

Honolulu, HI

$17.25 - $21/hr

... grievance requests, participate in the Medicare annual plan build implementation and testing, manage the Pharmacy help desk line, assist Customer Service on drug-related concerns/issues for the ...

AlohaCare

Pharmacy Technician

Honolulu, HI

$17.25 - $21/hr

... grievance requests, participate in the Medicare annual plan build implementation and testing, manage the Pharmacy help desk line, assist Customer Service on drug-related concerns/issues for the ...

Humana

Grievance & Appeals Representative

$40K - $52K/yr

The Grievances & Appeals Representative 2 performs varied activities and moderately complex ... Prior experience with Medicare * Experience with the Claims Administration System (CAS) * Knowledge ...

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How much do medicare grievance jobs pay per hour?

As of Aug 17, 2026, the average hourly pay for medicare grievance in the United States is $17.21, according to ZipRecruiter salary data. Most workers in this role earn between $8.17 and $26.20 per hour, depending on experience, location, and employer.

What is a Medicare Grievance specialist?

Medicare Grievance specialists are professionals who handle complaints from Medicare beneficiaries regarding the quality of care or services received from healthcare providers or Medicare plans. They investigate concerns such as delays, poor service, or dissatisfaction with how medical needs were addressed. Their main role is to ensure that issues are resolved according to Medicare regulations and that patients’ rights are protected throughout the process. They also educate beneficiaries about their rights and help them navigate the grievance process.

What are some common challenges faced in a Medicare Grievance role and how can they be addressed?

Professionals in Medicare Grievance roles often encounter challenges such as managing a high volume of complex cases, adhering to strict regulatory timelines, and ensuring clear communication with both members and healthcare providers. Successfully navigating these challenges requires strong organizational skills, attention to detail, and a deep understanding of Medicare regulations. Building effective relationships with other departments, such as Compliance and Customer Service, can also help streamline case resolution and improve member satisfaction.

What are the key skills and qualifications needed to thrive as a Medicare Grievance specialist, and why are they important?

To thrive as a Medicare Grievance Specialist, you need a solid understanding of Medicare regulations, healthcare compliance, and experience in case management, often supported by a bachelor's degree in healthcare administration or a related field. Familiarity with claims processing systems, healthcare databases, and case tracking software is typically required. Strong attention to detail, problem-solving abilities, and excellent communication skills help specialists resolve complex member complaints and ensure regulatory compliance. These competencies ensure timely and accurate resolution of grievances, safeguarding both member rights and organizational integrity.

What is the difference between Medicare Grievance vs Medicare Claims Processor?

AspectMedicare GrievanceMedicare Claims Processor
Primary RoleHandle beneficiary complaints and issues related to Medicare servicesReview and process Medicare claims for payment
Required CredentialsKnowledge of Medicare policies, customer service skillsKnowledge of billing codes, claims processing systems
Work EnvironmentCustomer service centers, healthcare officesInsurance companies, healthcare providers

Medicare Grievance specialists focus on addressing beneficiary complaints about Medicare services, ensuring issues are resolved. In contrast, Medicare Claims Processors handle the review and processing of claims for payment. While both roles require knowledge of Medicare policies, grievances emphasize customer service, whereas claims processing centers on billing and coding. Understanding these differences helps clarify each role's responsibilities within the Medicare system.

How long does Medicare have to resolve a grievance?

Medicare is required to resolve a grievance within 30 days of receiving the complaint. If additional information is needed, the resolution period can be extended up to 60 days. Medicare claims representatives or customer service staff handle these processes, ensuring timely responses to beneficiaries' concerns.

What qualifies as a grievance in Medicare?

A Medicare grievance is a formal complaint filed by a beneficiary or provider regarding issues such as denied coverage, poor service, or billing errors. It involves expressing dissatisfaction with Medicare services or decisions and can be submitted through the Medicare appeals process or customer service channels.

Who handles Medicare grievances?

Medicare grievances are handled by the Medicare Administrative Contractors (MACs), who are responsible for processing and resolving complaints related to Medicare services. These agencies review grievances, investigate issues, and ensure compliance with Medicare regulations, often requiring knowledge of healthcare policies and documentation procedures.
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What job categories do people searching Medicare Grievance jobs look for?

The top searched job categories for Medicare Grievance jobs are:

Medicare Grievance jobs near you
Infographic showing various Medicare Grievance job openings in the United States as of August 2026, with employment types broken down into 4% As Needed, 79% Full Time, 14% Part Time, and 3% Contract. Highlights an 88% Physical, 2% Hybrid, and 10% Remote job distribution, with an average salary of $35,799 per year, or $17.2 per hour.

Appeals & Grievance Coordinator

Imperial Management Administrators Services Inc

Pasadena, CA • On-site

$26 - $28/hr

Full-time

Re-posted 19 days ago

Job description

Imperial is seeking an Appeals and Grievances coordinator to help with the exchange side of Medical. Experienced and familiar with NCQA regulations.


Responsible for reviewing and resolving member complaints and appeals and communicating resolution to members in accordance with the standards and requirements established by Medicare and applicable state insurance regulations for the Exchange.

ESSENTIAL JOB FUNCTIONS:

  1. Responsible for providing administrative support to ensure grievance and appeal cases are processed per regulatory guideline and internal department protocol including:
  2. Coordinate, document and track all members, grievances and member and provider appeals and or grievances.
  3. Generates written correspondence to members and providers and using appropriate grammar and punctuation.
  4. Ensure all grievance and appeal communications are sent out within regulatory compliance guidelines.
  5. Researches issues utilizing internal systems, outreach to providers, vendors and internal departments in order to fully respond to all issues raised in a grievance or to resolve appeal.
  6. Requests medical records, clinical notes, and responses from providers, vendors and internal departments as needed.
  7. Maintains working knowledge of regulatory guidelines surrounding grievances and appeals per Medicare and state regulations and per internal A & G policies & procedures.
  8. Acts as a liaison between departments to coordinate information and close grievances and appeals within regulatory timelines.
  9. Keeps A & G leadership aware of “open’ & “pending” grievance and appeal cases and expected resolution measures.
  10. Adheres to payroll policies and properly uses timekeeping system with minimal manual changes.
  11. Maintains regular and consistent attendance.

EDUCATION/EXPERIENCE:

  • High school graduate or equivalent.
  • 1 year of Medicare A&G experience required.
  • Must have experience in making outgoing phone calls as well as taking incoming phone inquiries