Job Description

Health Services Specialist I – Appeals & Grievances

Location: Onsite to start, Hybrid after training

Schedule: Monday – Friday, 8:30 AM – 5:00 PM (flexible by ~30–60 minutes)

About the Role

We are seeking a Health Services Specialist I to support the Managed Care Operations team. This role is ideal for someone who has experience in healthcare appeals and grievances (A&G) and is looking for an opportunity to grow with a well-respected organization.

This position will begin onsite for training (2–4 weeks) and then transition to hybrid :

• Initially 4 days onsite / 1 remote (or 3 in / 2 out)
• Potentially 2 days onsite / 3 remote once performance is established

There is a strong possibility of a Contract-to-Hire opportunity based on performance and volume needs.

Day-to-Day Responsibilities

• Review, document, and coordinate appeals and grievances from health plans.
• Manage assigned cases through SharePoint , ensuring deadlines are met.
• Conduct daily outreach calls to provider offices for coordination of best site of service for outpatient surgeries.
• Notify providers with new referrals when member eligibility status has changed.
• Track and document all activities accurately.
• Monitor the group grievance email and prioritize assignments based on due dates.
• Collaborate with team members to support case volume as needed.
• Assist with process improvements and support ongoing workflow initiatives.

Required Qualifications

• Minimum 2 years of experience in healthcare related to grievances, care coordination, or member services.
• Basic knowledge and understanding of Appeals & Grievances (A&G).
• Strong organizational skills with the ability to prioritize time-sensitive work.
• Proficient in Microsoft Office (Word, Excel, PowerPoint).
• Excellent verbal and written communication skills.
• Comfortable making and receiving provider calls daily.

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