What are the responsibilities and job description for the Grievance & Appeals Coordinator position at Pyramid Consulting, Inc?
Immediate need for a talented Grievance & Appeals Coordinator. This is a 12 Months Contract opportunity with long-term potential and is US (Remote). Please review the job description below and contact me ASAP if you are interested.
Job Diva ID: 26-00137
Pay Range: $22.00 - $23.00/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
By applying to our jobs, you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy [Link available when viewing the job].
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Job Diva ID: 26-00137
Pay Range: $22.00 - $23.00/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:
- Process and resolve member appeals and grievances in accordance with internal policies, timelines, and regulatory requirements
- Review case documentation for completeness, accuracy, and compliance
- Maintain clear and professional communication with internal stakeholders regarding case status and resolution
- Draft clear, accurate, and compliant written correspondence related to appeals and grievances
- Collaborate with team members on complex cases and contribute to case discussions
- Identify trends, issues, or improvement opportunities within case workflows
- Support quality initiatives aimed at meeting or exceeding performance benchmarks
- Maintain detailed and accurate records within internal systems
Key Requirements and Technology Experience:
- Key Skills; 2-3 years of experience in appeals and grievances, healthcare administration, insurance operations, or another regulated environment
- Strong knowledge of federal and state healthcare regulations (Medicare/Medicaid preferred)
- Demonstrated letter-writing or formal correspondence experience
- Strong attention to detail and accuracy
- Effective written and verbal communication skills
- Ability to manage multiple cases and deadlines in a fast-paced environment
- Knowledge of healthcare regulations, including Medicare and Medicaid guidelines
- Experience handling complex or compliance-related cases
- Strong conflict resolution and customer service skills
- Exposure to cross-functional coordination or project support
- Consistently meet or exceed quality benchmarks (approximately 97% accuracy)
- Resolve cases within required turnaround times
- Demonstrate strong collaboration and proactive communication
- Contribute to customer satisfaction through effective case resolution
- High School Diploma or GED
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
By applying to our jobs, you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy [Link available when viewing the job].
#profJ2W:CB3
Salary : $22 - $23