The role
This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Grievance Specialist based in the United States.
This fully remote role focuses on resolving member grievances accurately, compassionately, and within required regulatory timelines.
You will investigate cases, review member records and applicable policies, and identify the underlying causes of concerns.
The position combines healthcare operations, regulatory compliance, customer service, documentation, and cross-functional collaboration.
You will communicate directly with members, including individuals who may be frustrated or vulnerable, while working to build trust and provide clear resolutions.
Your work will also contribute to identifying recurring issues and opportunities to improve processes and the overall member experience.
Success requires strong attention to detail, sound judgment, organization, and the ability to manage changing priorities and case volumes.
This is an opportunity to make a meaningful impact in a member-focused healthcare environment while applying your Medicare and grievance-management expertise.
Accountabilities
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Maintain current knowledge of healthcare products, benefits, policies, procedures, and applicable grievance requirements.
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Conduct thorough grievance investigations by reviewing case details, member records, policies, procedures, and other relevant information to identify root causes.
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Triage and categorize grievances accurately, ensuring cases are routed appropriately and handled according to established processes.
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Communicate with members by telephone and written correspondence, providing clear, professional, and empathetic support while meeting regulatory requirements.
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Document investigations, decisions, communications, and case activity accurately across multiple systems.
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Ensure grievances are resolved within applicable regulatory and departmental timelines.
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Collaborate with internal stakeholders to gather information, investigate concerns, and develop complete and appropriate resolutions.
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Escalate complex cases when additional expertise or support is required and help facilitate timely resolution.
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Identify recurring grievance themes, operational issues, and member-experience opportunities that can inform process improvements.
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Contribute to a culture of continuous learning, member advocacy, accuracy, and regulatory compliance.
Requirements
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Demonstrated experience handling Medicare Advantage appeals and grievances; Medicare experience is required.
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Bachelor’s degree or equivalent relevant experience in healthcare, conflict resolution, or a related field preferred.
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Working knowledge of healthcare insurance products, policies, procedures, and claims processes.
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Strong investigative, analytical, and problem-solving abilities, with the capacity to assess complex case information and determine appropriate next steps.
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Exceptional attention to detail and a strong commitment to documentation and data accuracy.
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Excellent written and verbal communication skills, including the ability to explain complex information clearly and concisely.
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Strong customer service and conflict-resolution skills, particularly when supporting members who may be frustrated, concerned, or vulnerable.
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Strong organizational and time-management skills, with the ability to manage multiple cases and consistently meet deadlines.
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Experience escalating cases and collaborating effectively with internal stakeholders across different functions.
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Strong computer and documentation skills, with the ability to work confidently across multiple platforms and systems.
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Adaptability and resilience when regulations, priorities, workloads, or case volumes change.
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Ability to work independently while contributing effectively within a collaborative team environment.
Benefits
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Remote work within the United States.
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Hourly salary range of $23–$26, with actual compensation based on qualifications, relevant experience, skills, education, certifications, and location.
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Employer-sponsored medical, dental, and vision coverage, with low- or no-premium options.
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Generous paid time off.
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$100 monthly mobile or internet stipend.
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Stock options available to employees.
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Bonus eligibility for applicable roles.
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401(k) retirement program.
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Parental leave program.
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Employee-focused healthcare and wellness benefits.
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Additional total-rewards offerings for eligible full-time employees.
How Jobgether works:
We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.
We appreciate your interest and wish you the best!
Why Apply Through Jobgether?
Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.
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