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Remote Grievance Analyst Jobs (NOW HIRING)

Geisinger Health

Medical Director Medicaid

Danville, PA · On-site +1

Location: Pennsylvania (onsite/hybrid/remote with periodic in state travel) Reports to: Chief ... Oversee grievance and appeals clinical reviews and author evidence-based rationales. * Serves as ...

Crystal Ball

HR Manager

Palo Alto, CA · Remote

... Analytics industry. As an HR Manager, you will play a crucial role in managing human resources ... Ability to work effectively in a remote team environment

Verge Inc.

Customer Success Specialist

Fremont, CA · Remote

Monitor customer grievance process. Review reports and take appropriate actions. * Responsible for ... Ability to work remotely from a remote location * Deliver software demos * Engage clients in ...

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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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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.
Medical Director Medicaid

Medical Director Medicaid

Geisinger Health

Danville, PA • On-site, Remote

Full-time

Medical, Dental, Vision

Posted 11 days ago

Geisinger Health rating

6.8

Company rating: 6.8 out of 10

Based on 426 frontline employees who took The Breakroom Quiz

485th of 870 rated healthcare providers

Job description

Location:
Work from home (Pennsylvania)
Shift:
Rotation (United States of America)
Scheduled Weekly Hours:
40
Worker Type:
Regular
Exemption Status:
Yes
Job Summary:
Location: Pennsylvania (onsite/hybrid/remote with periodic in state travel)
Reports to: Chief Medical Officer
Department: Health Services / Medical Management
FLSA: Exempt | Employment Type: Full time
Job Duties:
Role Summary
Lead clinical strategy, medical management, and regulatory performance for our Medicaid line of business across Pennsylvania (and any adjacent markets we enter). Partner with Quality, Utilization Management, Case/Disease Management, Pharmacy, Behavioral Health, Provider Network, and Compliance to deliver high-quality, cost-effective care and strong outcomes for Medicaid members. Serve as the primary physician liaison with the state Medicaid agency and key provider partners, and ensure contractual and regulatory compliance.
Key Responsibilities
Clinical leadership & Medicaid program oversight
  • Provide clinical direction for the Medicaid product, including medical policy, clinical guidelines, and care model design across UM/CM/DM.
  • Provide physician leadership for utilization management (prospective, concurrent, retrospective), complex case reviews, and peer-to-peer discussions. Ensure determinations are clinically sound and timely.
  • Oversee grievance and appeals clinical reviews and author evidence-based rationales.
  • Serves as clinical lead for GHP on meetings with DHS and other external stakeholders with strong understanding of contractual and regulatory requirements, in partnership other GHP departments.

Regulatory, accreditation & quality
  • Ensure compliance with state Medicaid contract requirements and with NCQA/URAC, CMS, and state Department of Health rules; support surveys, audits, and reporting.
  • Drive quality improvement (e.g., HEDIS-aligned initiatives), close gaps in care, and monitor outcomes and utilization trends; partner with Quality to design performance interventions.
  • Maintain familiarity with Pennsylvania regulatory expectations (e.g., DOH reporting under applicable code) and represent the plan in required state meetings.

Provider engagement & network collaboration
  • Serve as clinical liaison to hospitals, systems, and practices; educate on medical policies/criteria (e.g., InterQual/MCG), practice guidelines, and performance opportunities.
  • Collaborate with Provider Network on value-based models, performance feedback, appeals resolution themes, and market growth priorities.

Cross-functional partnership
  • Partner with Pharmacy on formulary strategy and prior authorization criteria; with Behavioral Health on integrated medical/behavioral management; with Social Care/Population Health on SDoH and equity initiatives.
  • Contribute physician expertise to clinical analytics, trend reviews, fraud/waste/abuse investigations, and policy updates.

External representation
  • Act as the plan's clinical spokesperson with the state Medicaid agency and advisory bodies; participate in accreditation committees, stakeholder forums, and community partnerships.
  • Represents GHP in meetings with other MCO's and appropriately manages information shared between organizations

Minimum Qualifications (Required)
  • MD or DO, board certified (ABMS/AOA).
  • Active Pennsylvania medical license or eligibility to obtain PA licensure within 6 months of hire.
  • 5-7+ years clinical practice plus 3+ years in a health-plan medical leadership role (Medical Director or Deputy) specific to Medicaid (multi-state plan experience required-e.g., oversight in at least one additional state or a regional program).
  • Demonstrated experience with utilization management, appeals/grievances, and medical policy in a managed care setting.
  • Working knowledge of NCQA/URAC standards and state Medicaid regulatory requirements; familiarity with CMS expectations for managed care.
  • Must primarily reside in PA and have a home address in PA or willing to relocate.

Preferred Qualifications
  • Direct Pennsylvania Medicaid experience (e.g., DHS engagement, PA DOH reporting, CHC/HealthChoices familiarity).
  • Background in population health, value-based payment, behavioral health integration, and LTSS.
  • Preferred Certification: Certified Professional in Healthcare Quality (CPHQ). Or obtain upon hire within the first year of employment.
  • Familiarity with InterQual/MCG criteria and care management platforms; comfort using data to guide clinical operations and provider performance.

Core Competencies
  • Evidence-based decision-making; concise clinical writing for determinations and appeals.
  • Collaborative leadership across UM, Quality, Pharmacy, BH, Network, and Compliance.
  • Executive presence with regulators, providers, and internal leadership.

Position Details:
Location: Pennsylvania (onsite/hybrid/remote with periodic in-state travel)
Education:
Doctor of Medicine or Doctor of Osteopathic Medicine- (Required)
Experience:
Minimum of 5 years-Clinical (Required), Minimum of 3 years-Health Insurance/Managed Care (Required)
Certification(s) and License(s):
Certified Professional in Healthcare Quality - The National Association for Healthcare Quality (NAHQ), Licensed Medical Doctor - State of Pennsylvania
Skills:
Medicaid, Office Administration, Population Health Management, Value Based Healthcare
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities.
  • KINDNESS: We strive to treat everyone as we would hope to be treated ourselves.
  • EXCELLENCE: We treasure colleagues who humbly strive for excellence.
  • LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow.
  • INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
  • SAFETY: We provide a safe environment for our patients and members and the Geisinger family.

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality.
We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.

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