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Grievance & Appeals Coordinator I

Location: Remote within Ohio; occasional training may take place in Columbus
Schedule: Monday–Friday, 8:00 a.m.–5:00 p.m., with a one-hour lunch
Assignment: Six-month contract with potential for extension or permanent placement
Anticipated Start Date: August 3, 2026
Openings: Two

Pay Rate:  $23/hr

Position Overview

The Grievance & Appeals Coordinator I reviews and resolves member grievances, provider disputes, claims appeals, and authorization appeals. This production-focused role requires careful research, professional written communication, and consistent adherence to regulatory and internal deadlines.

The coordinator will manage cases through a work queue, prioritize aging inventory, prepare accurate correspondence, and maintain complete case documentation. This position is ideal for someone who is organized, adaptable, and comfortable working in a fast-paced, compliance-driven healthcare environment.

Key Responsibilities

• Review and analyze verbal and written complaints, grievances, disputes, and appeals submitted by members and providers.

• Research claims, authorization decisions, and supporting documentation to help resolve cases accurately and promptly.

• Prepare clear and professional response letters for members and providers.

• Maintain complete and accurate files for individual grievances, disputes, and appeals.

• Monitor assigned work queues and meet established productivity, quality, and turnaround-time standards.

• Prioritize cases according to age, urgency, and regulatory requirements.

• Coordinate or provide administrative support for grievance and appeals committee activities as needed.

• Support quality and performance programs through data entry, tracking, research, and information organization.

• Assist with healthcare quality reporting activities, provider outreach, and claims research.

• Process large volumes of documents through copying, scanning, faxing, and incoming-mail management.

• Communicate regularly through email and collaboration platforms to request assistance, provide updates, and respond to changing priorities.

• Work with clinical professionals, medical leadership, case managers, claims specialists, and other internal partners.

• Protect confidential member and provider information and comply with applicable privacy requirements, policies, and regulations.

Required Qualifications

• High school diploma or equivalent.

• Strong verbal and written communication skills.

• Strong analytical, research, and problem-solving abilities.

• Ability to meet deadlines in a fast-paced, compliance-focused environment.

• Ability to organize detailed information and maintain accurate records.

• Ability to adapt to changing priorities, regulations, and business needs.

• Proficiency with Microsoft Word, Excel, Outlook, Teams, and SharePoint.

Preferred Qualifications

• Associate degree.

• Two or more years of experience in grievances and appeals, claims, managed care, healthcare administration, or a related field.

• Familiarity with Medicaid, Medicare, and/or Health Insurance Marketplace programs.

• Experience working with case-management systems, production queues, or high-volume document workflows.

• Knowledge of healthcare regulations, required turnaround times, or quality standards.

Measures of Success

• Completing assigned cases accurately and within required deadlines.

• Producing clear, professional, and compliant written correspondence.

• Maintaining organized and thorough case documentation.

• Balancing productivity expectations with close attention to quality.

• Communicating proactively when questions or barriers arise.

• Responding constructively to shifting priorities and changing healthcare requirements.

• Contributing to a supportive, accountable, and collaborative team environment.

What the Role Offers

This position provides an opportunity to perform meaningful work that directly affects healthcare members and providers. The successful candidate will collaborate with clinical and non-clinical professionals while gaining valuable experience in healthcare operations, regulatory guidelines, claims research, and multiple insurance programs.

Strong performance may lead to consideration for an assignment extension or future permanent opportunities, depending on business needs.