Grievance Specialist

Why consider this job opportunity

• Salary range up to $80,070 for Greater New York City Area residents
• Comprehensive benefits package including medical, dental, and vision coverage
• Incentive and recognition programs to reward outstanding performance
• 401k contributions to support your retirement savings
• Opportunity for career advancement within the organization
• Work in a non‑clinical role that focuses on member advocacy and complaint resolution

What to Expect (Job Responsibilities)

• Independently manage a caseload of grievances from initiation to resolution, including drafting written member resolution letters
• Conduct detailed research by collaborating with internal departments to identify root causes and recommend resolutions
• Partner with external vendors to address member issues related to subcontracted services and ancillary benefits
• Ensure timely and accurate documentation of cases in compliance with regulatory requirements and audit standards
• Participate in department meetings, quality audits, training sessions, and performance reviews as necessary

What is Required (Qualifications)

• High School Diploma or GED from an accredited institution
• Understanding of utilization management processes and their impact on member access to care and claims payment
• Proficient in Microsoft Office Suite, including Excel, Word, PowerPoint, Outlook, and case tracking systems
• Ability to meet department metrics for production and quality
• Strong written and verbal communication skills

How to Stand Out (Preferred Qualifications)

• Bachelor’s degree or equivalent experience in healthcare, public health, or a related field
• 2+ years of experience in managed care, member services, or healthcare grievances or complaints resolution
• Working knowledge of Medicare Advantage, Medicaid Managed Care, and Health Insurance Exchange programs
• Familiarity with relevant state and federal regulatory requirements, including CMS regulations
• Experience with claims processing and provider billing workflows

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We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top‑tier employer.