Grievance & Appeals Coordinator in 100% Remote -- Iowa candidates only

BCforward is currently seeking a highly motivated Grievance & Appeals Coordinator for an opportunity in 100% Remote — Iowa candidates only

Position Title: Grievance & Appeals Coordinator I 

Location: 100% Remote — Iowa candidates only

Duration: 6 Months (Possible Extension)

Schedule: Monday–Friday, 8:30 AM–5:00 PM CST

Pay Rate: $19.77/hr. on W2

Job Description:

We are seeking a Grievance & Appeals Coordinator I to review and resolve member and provider complaints, grievances, and appeals. This position will investigate concerns, communicate with members and providers, maintain accurate case documentation, and provide written resolutions within required turnaround times.

The ideal candidate is organized, self-motivated, detail-oriented, and an excellent communicator with experience in grievances, appeals, claims, managed care, healthcare, or a call center environment.

Key Responsibilities

• Review and process verbal and written member and provider grievances and appeals.
• Investigate complaints and gather information needed to determine appropriate resolutions.
• Make outbound calls to members to explain the grievance process and obtain additional information.
• Prepare written response letters for members and providers.
• Maintain accurate documentation and case files.
• Organize and manage caseloads according to required due dates and turnaround times.
• Complete case documentation in internal systems.
• Research claims and member/provider information as needed.
• Support HEDIS-related activities, including data entry, provider calls, and claims research.
• Support pay-for-performance programs through data entry, tracking, organization, and research.
• Assist with Grievance & Appeals Committee activities when needed.
• Manage high volumes of documents, including copying, faxing, scanning, and processing incoming mail.
• Maintain accuracy, confidentiality, and professionalism when handling sensitive information.

Required Qualifications

• High School Diploma or GED required.
• 2 years of experience in grievances, appeals, claims, managed care, healthcare, or a related field preferred.
• Strong verbal and written communication skills.
• Strong problem-solving and analytical abilities.
• Excellent organization and time-management skills.
• Ability to manage multiple cases and competing priorities.
• Strong attention to detail.
• Ability to work independently and meet contractual deadlines.
• Previous call center/customer service experience is helpful.

Benefits:

BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.