Appeals and Grievance Specialist - Work from Home

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 environment, where showing up authentically matters.

What to Expect:

• On-camera participation during interviews, training, team meetings, and regular check-ins.
• Face-to-face discussions sparking collaboration and engagement
• A supportive atmosphere where you can express yourself openly and be part of a team that values your contributions.

Benefits:

• Medical, Dental, and Vision coverage.
• Life Insurance.
• Short-Term and Long-Term Disability options.
• Flexible Spending Account (FSA).
• Employee Assistance Program.
• 401(k) with employer contribution.
• Paid Time Off (PTO).
• Tuition Reimbursement.

BroadPath, a Sagility Company, may conduct background checks, previous employment verifications, and education verifications, based on position requirements

Diversity Statement
 

At BroadPath, a Sagility Company, diversity is our strength. We embrace individuals from all backgrounds, experiences, and perspectives. We foster an inclusive environment where everyone feels valued and empowered. Join us and be part of a team that celebrates diversity and drives innovation!

Equal Employment Opportunity/Disability/Veterans 

If you need accommodation due to a disability, please email us at [email protected]. This information will be held in confidence and used only to determine an appropriate accommodation for the application process 

BroadPath, a Sagility Company, is an Equal Opportunity Employer. We do not discriminate against our applicants on the basis of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age, disability, veteran status, genetic information, or any other status protected by applicable law. 

Compensation: BroadPath a Sagility Company has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and the market data of the position. The actual salary for this role may vary by location. 

Location:

Work@Home USAUnited States of America