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Remote Grievance Analyst Jobs (NOW HIRING)

HealthEdge

Appeals RN (Temporary)

$50/hr

Appeals and grievance experience required. * Strong problem-solving skills, facilitation skills, and analytical skills. Geographic Responsibility: Remote, US Type of Employment: Full-time, permanent ...

HealthEdge

Appeals RN (Temporary)

$50/hr

Appeals and grievance experience required. * Strong problem-solving skills, facilitation skills, and analytical skills. Geographic Responsibility: Remote, US Type of Employment: Full-time, permanent ...

Arizona Department of Administration

$55K - $62K/yr

REMOTE OPTIONS, PHOENIX Categories: Administrative Support/Customer Service, Human Resources ... grievances, and conducts investigations. Provides guidance to management on disciplinary actions ...

MedReview

Appeals Specialist II

Manhattan, NY · On-site +1

$50K - $55K/yr

... investigation, and analysis of appeals, grievances, and other types of complaints filed by ... frequent interruptions Remote Work Requirements * High speed internet (100 Mbps per person ...

MedReview

Appeals Specialist II

Manhattan, NY · Remote

... investigation, and analysis of appeals, grievances, and other types of complaints filed by ... frequent interruptions Remote Work Requirements * High speed internet (100 Mbps per person ...

CONFIDENTIAL

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REMOTE: Employee Relations Specialist

Sacramento, CA · Remote

$30 - $35/hr

Evaluate and address Associate grievances, identifying and recommending any appropriate action ... Solid research, analysis, and problem-solving skills * Advanced level knowledge of federal and ...

Labcorp

Senior Manager, Labor Relations

$130K - $150K/yr

Labcorp is seeking a remote Senior Manager, Labor Relations to join our team! Job Responsibilities ... ANALYTICS & LABOR INTELLIGENCE • Analyze internal and external labor trends and provide ...

Phsorg

Remote: Open to applicants in the United States, excluding CA, IL, ND, NY, OH, WA, and WY. Hybrid ... Provide executive oversight for analytics supporting claims, appeals and grievances, call center ...

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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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What cities are hiring for Remote Grievance Analyst jobs? Cities with the most Remote Grievance Analyst job openings:
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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 June 2026, with employment types broken down into 15% Locum Tenens, 4% Internship, 7% As Needed, 29% Full Time, 4% Temporary, and 41% Contract. Highlights an 81% Physical, 8% Hybrid, and 11% Remote job distribution.
Appeals RN (Temporary)

Appeals RN (Temporary)

HealthEdge

Remote

$50/hr

Contractor

Posted 11 days ago

Job description

Overview
Overview:
In this role you should independently be able to effectively and efficiently process the transactions assigned in a timely manner, clarify complex transactions to others and ensure that quality of output and accuracy of information is maintained, in alignment with SLAs.
RESPONSIBILITIES/TASKS:
  • Investigate and process complex grievances and appeals requests from members and providers
  • Perform reviews of inpatient, outpatient, ambulatory and ancillary services for medical necessity
  • Review, research, and prepare documentation related to appeals and grievances in accordance with local, state, and federal regulatory and designated accreditation (e.g., NCQA) standards
  • Prepare recommendations to either uphold or deny appeal and work with the Medical Director for further review
  • Document and logs appeal/grievance information on relevant tracking systems
  • Generate written correspondence to providers, members, and regulatory entities
  • Serve as a subject matter expert for appeals, grievances, and quality of care issues
  • Utilize leadership skills
  • Assist with or perform other relevant essential functions as required

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.
EMPLOYMENT QUALIFICATIONS:
EDUCATION:
Bachelor's degree in nursing, allied health, business, or related field preferred. Registered Nurse with current unrestricted Registered Nurse license required. Certification in Case Management may be preferred based upon designated department assignment.
EXPERIENCE:
Minimum two (2) years of clinical experience which may include acute patient care, discharge planning, case management, and utilization review, etc. Demonstrated clinical knowledge and experience relative to patient care and health care delivery processes. One (1) year health insurance plan experience or managed care environment preferred.
SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
  • Unrestricted USRN mainland license
  • At least 2 years experience in utilization management / review
  • Demonstrated clinical knowledge and experience relative to patient care and healthcare delivery processes. Medicare Advantage experience an advantage
  • Excellent written and verbal communication skills.
  • Excellent customer service and interpersonal skills.
  • Working knowledge of current industry Microsoft Office Suite PC applications.
  • Ability to apply clinical criteria/guidelines for medical necessity, setting/level of care, and concurrent patient management
  • Knowledge of current standard medical procedures/practices and their application as well as current trends and developments in medicine and nursing, alternative care settings, and levels of service
  • Knowledge of applicable accreditation standards, and local, state, and federal regulations
  • Appeals and grievance experience required.
  • Strong problem-solving skills, facilitation skills, and analytical skills.

Geographic Responsibility: Remote, US
Type of Employment: Full-time, permanent
FLSA Classification (USA Only): Exempt
Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:
  • The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
  • Work across multiple time zones in a hybrid or remote work environment.
  • Long periods of time sitting and/or standing in front of a computer using video technology.
  • May require travel dependent on company needs.

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990. Candidates may be required to go through a pre-employment criminal background check.
HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities.
#LI-Remote
**The annual US base salary range for this position is $50/hr. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education.
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About HealthEdge

Sourced by ZipRecruiter

Health Edge ® provides modern, disruptive technology that delivers for the first time, a suite of products that enables healthcare payors to leverage new business models, improve outcomes, drastically reduce administrative costs and connect everyone in the healthcare delivery cycle. Our next-generation enterprise product suite, HealthRules ®, is built on modern, patented technology and is delivered to customers via the HealthEdge Cloud or on-site deployment. An award-winning company, HealthEdge empowers payors to capitalize on the innovations, challenges and opportunities that await in the new healthcare economy. For more information, visit .

Industry

Computer and computer peripheral equipment and software wholesalers

Company size

201 - 500 Employees

Headquarters location

Burlington, MA, US

Year founded

2005

Social media

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