Grievance Specialist

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.

• Demonstrated experience handling Medicare Advantage appeals and grievances; Medicare experience is required.

• Bachelor’s degree or equivalent relevant experience in healthcare, conflict resolution, or a related field preferred.

• Working knowledge of healthcare insurance products, policies, procedures, and claims processes.

• Strong investigative, analytical, and problem-solving abilities, with the capacity to assess complex case information and determine appropriate next steps.

• Exceptional attention to detail and a strong commitment to documentation and data accuracy.

• Excellent written and verbal communication skills, including the ability to explain complex information clearly and concisely.

• Strong customer service and conflict-resolution skills, particularly when supporting members who may be frustrated, concerned, or vulnerable.

• Strong organizational and time-management skills, with the ability to manage multiple cases and consistently meet deadlines.

• Experience escalating cases and collaborating effectively with internal stakeholders across different functions.

• Strong computer and documentation skills, with the ability to work confidently across multiple platforms and systems.

• Adaptability and resilience when regulations, priorities, workloads, or case volumes change.

• Ability to work independently while contributing effectively within a collaborative team environment.