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Remote Grievance Analyst Jobs (NOW HIRING)

CareFirst

Appeals Specialist I (Remote)

Baltimore, MD · Remote

The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and determination of next steps for the following line of business: Commercial. The ...

Pacer Group

Medical Review RN IV

$50/hr

Medical Review RN IV - Commercial Appeals & Grievance Nurse Location: Remote - Candidate Must ... Analyze pre-service and post-service appeals involving medical necessity, benefit determinations ...

City of Bellevue, WA

Labor Analyst

Bellevue, WA · On-site +1

$88K - $121K/yr

Regular Remote Employment: Flexible/Hybrid Job Number: 26-00232 Department: Human Resources ... grievance meetings, and other types of labor related meetings with the purpose of identifying ...

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Remote Grievance Analyst information

How does a Remote Grievance Analyst typically collaborate with other departments to resolve member issues?

As a Remote Grievance Analyst, you’ll regularly coordinate with departments such as claims, customer service, and medical management to thoroughly investigate and resolve member grievances. Effective communication through virtual meetings, emails, and shared documentation is key to gathering the necessary information and ensuring all perspectives are considered. This collaborative approach helps to address member concerns efficiently and ensures compliance with regulatory requirements. Being proactive and detail-oriented will help you build strong working relationships and contribute to positive outcomes for both members and the organization.

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

To thrive as a Remote Grievance Analyst, you need expertise in claims processing, regulatory compliance, and case management, typically supported by a bachelor's degree in a relevant field or equivalent experience. Familiarity with case management systems, health plan software, and knowledge of Medicaid/Medicare regulations is commonly required. Attention to detail, analytical thinking, and effective written communication are critical soft skills for investigating and resolving member or provider complaints. These skills are essential to ensure fair, timely resolutions, maintain compliance, and uphold member satisfaction in a remote work environment.

What is the difference between Remote Grievance Analyst vs Remote Customer Service Representative?

AspectRemote Grievance AnalystRemote Customer Service Representative
Required CredentialsTypically requires a bachelor's degree in HR, social sciences, or related fields; certifications in conflict resolution are a plusHigh school diploma or equivalent; customer service or communication certifications beneficial
Work EnvironmentPrimarily analytical, reviewing complaints, and resolving disputes within HR or legal frameworksDirect interaction with customers via phone, email, or chat to address inquiries and resolve issues
Employer & Industry UsageUsed mainly in HR, legal, or corporate compliance departmentsCommon across retail, tech, healthcare, and service industries

The main difference is that Remote Grievance Analysts focus on reviewing and resolving employee or customer complaints within HR or legal contexts, requiring analytical skills and specific certifications. In contrast, Remote Customer Service Representatives primarily handle direct customer interactions to solve issues, emphasizing communication skills. Both roles are remote but serve different functions within organizations.

What is a Remote Grievance Analyst?

A Remote Grievance Analyst is a professional who reviews, investigates, and resolves complaints or grievances, often related to healthcare, insurance, or employee relations, while working from a remote location. They analyze cases, ensure compliance with relevant regulations and company policies, and communicate findings and outcomes to involved parties. This role typically requires strong analytical, communication, and problem-solving skills, as well as the ability to work independently. Remote Grievance Analysts play a key role in ensuring fairness and accountability in organizational processes.
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Remote Grievance Analyst jobs near you
Infographic showing various Remote Grievance Analyst job openings in the United States as of July 2026, with employment types broken down into 1% Locum Tenens, 1% Internship, 86% Full Time, 6% Part Time, 1% Temporary, and 5% Contract. Highlights an 82% Physical, 5% Hybrid, and 13% Remote job distribution.

(REMOTE) Appeals and Grievance Representative

Widescope Consulting and Contracting Services LLC

Powder Springs, GA • Remote

$17.75/hr

Full-time

Medical, Dental, Vision, Retirement

This job post has expired today. Applications are no longer accepted.

Job description

Locations: Alabama, Florida, Georgia, Illinois, Kentucky, Maryland, North Carolina, South Carolina, Tennessee, Texas, Virginia, and Washington State

Position Type: Full-Time | Remote

Pay Rate: $17.75/hour base pay plus an additional $5.36/hour applied toward health and welfare benefits or retirement (depending on benefit election).If health benefits are not needed (candidate has TRICARE, VA, or spouse provided health coverage) the $5.36 per hour is placed in a 401(a)-tax deferred account where 3% of the funds are matched by the company. If the candidate needs health, vision, dental insurance from the company, the $5.36 per hour pay is applied to cover health benefit options selected.

Position Summary:

Widescope Consulting and Contracting is urgently hiring experienced Appeals and Grieveance Representatives to support a remote healthcare initiative. In this role, you will be responsible for reviewing, researching, and resolving member and provider appeals and grievances with accuracy and professionalism. We are seeking candidates who can start right away and bring strong claims experience, problem-solving skills, and attention to detail.

Key Responsibilities:

  • Review and resolve appeal and grievance cases
  • Research underlying issues and apply appropriate policy guidelines (CMS, TRICARE)
  • Communicate decisions clearly with internal teams and external parties
  • Maintain organized, accurate documentation for each case
  • Work independently in a fast-paced, non-scripted environment

Required Qualifications:

  • High School Diploma / GED (or higher)
  • 2+ years of healthcare claims benefits experience (including denial research)
  • 1+ year of customer service experience
  • 1+ year of claims appeal experience
  • Proficiency in Microsoft Word and Excel

Preferred Skills:

  • Familiarity with TRICARE or Medicare (CMS) policies and procedures
  • Strong time managment and analytical thinking
  • Excellent verbal and written communication skills

Remote Work Requirements:

  • A quiet, dedicated home workspace free of distractions
  • Reliable high-speed internet (minimum 50Mbps down / 7 Mbps up)
  • Wired internet connection (LAN) preferred
  • Ability to perform basic troubleshooting with phone support from tech team
  • Company-provided equipment (computer, monitors, webcam, headset, cables) and support.

Apply now! We are hiring immediately and reviewing qualified candidates on a rolling basis.

Apply