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Remote Grievance Analyst Jobs (NOW HIRING)

Centene

Grievance and Appeals Coordinator I

$19.43 - $32.98/hr

Position is remote. Must live in Arizona. Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from ...

Humana

Grievance & Appeals Representative

$40K - $52K/yr

... analytic review of clinical documentation to determine if an a grievance, appeal or further request ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...

Humana, Inc.

Grievance & Appeals Representative

$40K - $52K/yr

... analytic review of clinical documentation to determine if an a grievance, appeal or further request ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...

Humana

Grievance & Appeals Representative

$40K - $52K/yr

... analytic review of clinical documentation to determine if an a grievance, appeal or further request ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...

Minnesota Jobs

Grievance & Appeals Representative

$40K - $52K/yr

... analytic review of clinical documentation to determine if an a grievance, appeal or further request ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...

Humana

Grievance & Appeals Representative

$40K - $52K/yr

... analytic review of clinical documentation to determine if an a grievance, appeal or further request ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...

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Remote Grievance Analyst information

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.

What are the key skills and qualifications needed to thrive as a remote grievance analyst?

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.

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 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.

More about Remote Grievance Analyst jobs

What cities are hiring for Remote Grievance Analyst jobs?

Cities with the most Remote Grievance Analyst job openings:

What states have the most Remote Grievance Analyst jobs?

States with the most job openings for Remote Grievance Analyst jobs include:

What job categories do people searching Remote Grievance Analyst jobs look for?

The top searched job categories for Remote Grievance Analyst jobs are:

Remote Grievance Analyst jobs near you
Infographic showing various Remote Grievance Analyst job openings in the United States as of August 2026, with employment types broken down into 50% Full Time, and 50% Contract. Highlights an 100% Remote job distribution.

Member Appeals & Grievance Analyst-2

Chattanooga, TN • On-site, Remote

BlueCross BlueShield of Tennessee
Insurance Services • 5 - 10K employees
Learn more about BlueCross BlueShield of Tennesseeexternal

$20 - $24.75/hr

Full-time

This job post has expired 5 days ago. Applications are no longer accepted.

Job description

We are hiring a Member Appeals & Grievance Analyst at BCBST!
In this role, you will review and process appeals and grievances submitted by members and providers, ensuring timely and accurate resolution in compliance with CMS and Medicare guidelines. You will evaluate cases, determine appropriate next steps, and manage multiple priorities while meeting required turnaround times.
You'll play a critical role in maintaining regulatory compliance, improving member experience, and supporting high-quality outcomes through detailed case analysis and effective use of digital tools to drive efficiency.
To be successful in this role, in addition to the core job requirements, you'll bring strong analytical skills, attention to detail, and a customer-focused approach. You will be a strong candidate if you have knowledge of Medicare and CMS regulations, as well as experience with the appeals and grievance process.
A clinical background or prior experience in a healthcare setting (preferred) will further strengthen your candidacy. Additionally, you should demonstrate strong data entry accuracy and case management skills, along with experience using or enthusiasm for leveraging AI tools (e.g., Copilot) to improve workflow efficiency.
We foster a culture where innovation is encouraged. That includes using AI enabled tools responsibly to support everyday work - guided by proven workflows, templates, and policies. As roles become more advanced, we expect employees to leverage AI more broadly to transform how we serve members.
Note
  • This is a fully remote role with a 40-hour work week, with flexibility required based on business needs, including required weekend coverage every weekend. An agreement to remain in the weekend role for a minimum of 2 years after completion of all training is required.
  • Sponsorship is not available for this role

Job Responsibilities
  • Documenting and investigating the substance of the appeal, grievance, or complaint and the action taken, including any aspects of clinical care or reimbursement issues involved.
  • Notifying involved parties of the outcome of a review (i.e. approval and/or denial of an appeal, grievance or complaint), including CMS and the member or appellant of the resolution of all CMS complaints in the appropriate timeframes as set forth by the applicable regulatory rules and regulations.
  • Providing excellent customer services to members, provider and CMS.
  • Maintaining knowledge of and adhering to CMS regulations and guidelines affecting the appeal/grievance/complaint process.

Job Qualifications
Education
  • Associates degree or equivalent work experience required

Experience
  • 2 years - Customer service and/or claims experience

Skills/Certifications
  • Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
  • Proficient oral and written communication skills
  • Proficient interpersonal and organizational skills
  • Ability to work independently under general supervision and collaboratively as part of a team in a fast paced environment
  • Capacity to solve problems and manage multiple assignments with critical deadlines; including analyzing claims, medical records & documents pertinent to the case review
  • Knowledge of CMS regulations and guidelines related to appeals, grievances and complaints

Number of Openings Available
1
Worker Type:
Employee
Company:
BCBST BlueCross BlueShield of Tennessee, Inc.
Applying for this job indicates your acknowledgement and understanding of the following statements:
BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.
Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:
BCBST's EEO Policies/Notices
BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

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