Appeals and Grievance Specialist - Work from Home

Job title
Appeals and Grievance Specialist - Work from Home

About Sagility

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members.

The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics.

Sagility has more than 25,000 employees across 5 countries.

Job title:

Appeals and Grievance Specialist - Work from Home

Job Description:

BroadPath, a Sagility Company, is hiring experienced Appeals and Grievance Specialists to join our remote team! The Appeals and Grievance Specialist reviews, investigates, and resolves complaints, grievances, and appeals submitted by members and providers.

This role serves as a key point of contact throughout the resolution process while ensuring cases are handled accurately, thoroughly, and in compliance with applicable requirements.

Schedules, pay rates, and program details may vary based on business needs and client assignment.

Compensation Highlights


* Base Pay: Starting at $18 per hour


* Pay frequency: Weekly pay

Schedule Highlights


* Schedules can fall between the hours of Monday-Friday, 8:00 AM - 5:00 PM Pacific Time, and will be assigned based on business needs

Responsibilities


* Manage and resolve complaints, grievances, and appeals from members and providers


* Serve as the primary contact throughout the investigation and resolution process


* Send acknowledgments and provide clear education on the grievance and appeal process


* Gather relevant information and research case details to determine an appropriate resolution


* Conduct fair, accurate, and timely case investigations


* Communicate resolutions to appropriate internal and external parties


* Ensure all required documentation is completed and maintained


* Follow established policies, procedures, and regulatory requirements


* Maintain productivity and quality standards in a structured workflow environment

Qualifications


* 1+ year of Medicare Appeals and Grievance or Medicare Claims experience required


* Experience with Medicare Part C or Part D preferred


* Familiarity with Windows based computer systems and the ability to learn new applications


* Strong technical and keyboarding skills


* Excellent verbal and written communication skills


* Ability to stay focused and productive in repetitive task-based work


* High School Diploma or equivalent

At BroadPath, a Sagility Company, we believe that transparency, authenticity, and collaboration are the keys to building strong, connected remote teams.

Being on camera is an integral part of our culture.

It is how we build relationships, share ideas, and stay engaged.

If you value open communication, connection, and teamwork, you will thrive in our ...