Job Details

Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.

Education/Experience: High school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals, claims or related managed care experience. Strong oral, written, and problem solving skills.
• Gather, analyze and report verbal and written member and provider complaints, grievances and appeals
• Prepare response letters for member and provider complaints, grievances and appeals
• Maintain files on individual appeals and grievances
• May coordinate the Grievance and Appeals Committee
• Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information
• Assist with HEDIS production functions including data entry, calls to provider's offices, and claims research.
• Manage large volumes of documents including copying, faxing and scanning incoming mail

EEO:

"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."

Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.

Education/Experience: High school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals, claims or related managed care experience. Strong oral, written, and problem solving skills.
• Gather, analyze and report verbal and written member and provider complaints, grievances and appeals
• Prepare response letters for member and provider complaints, grievances and appeals
• Maintain files on individual appeals and grievances
• May coordinate the Grievance and Appeals Committee
• Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information
• Assist with HEDIS production functions including data entry, calls to provider's offices, and claims research.
• Manage large volumes of documents including copying, faxing and scanning incoming mail
Story Behind the Need - Business Group & Key Projects

• Health plan or business unit
• Team culture
• Surrounding team & key projects
• Purpose of this team
• Reason for the request
• Motivators for this need
• ny additional upcoming hiring needs?

We anticipate decreased staffing in the upcoming months and an increase of inventory, as a result we need assistance to maintain the operations of our department. The team reviews provider disputes, member grievances and appeals with high focus on timeliness. We currently have 4 employees in equivalent roles that are readily available to field questions and motivate one another. The department is also being assessed for proper staffing needs and may find opportunities for employment in 2026. Typical Day in the Role

• Daily schedule & OT expectations
• Typical task breakdown and rhythm
• Interaction level with team
• Work environment description

The daily schedule is 8:00 - 5:00 with a 1 hour lunch to be taken between 11:00 and 1:00 M-F
This is production role, work will be provided through a queue using the CenPas system with high focus on aging and timeliness.
This is a close nit team with active engagement via Microsoft Teams Compelling Story & Candidate Value Proposition

• What makes this role interesting?
• Points about team culture
• Competitive market comparison
• Unique selling points
• Value added or experience gained

Candidates for this role will be joining a tight-knit team of Clinical Coordinators (licensed nurses) and Appeals & Grievances Coordinators (non-clinical professionals), the team works closely with Medical Directors, Case Managers, and Claims experts, creating a rich environment for learning and cross-functional engagement.. They'll be reviewing member appeals, grievances, and provider disputes. The work is deeply impactful, as it directly affects the lives of Medicaid members. They will gain hands-on experience with state contracts, NCQA guidelines, and internal systems that are foundational to healthcare operations. Our motto, "The only thing in healthcare is Change" is more than a saying. It's a mindset. We embrace change with resilience and readiness, supporting each other through shifting regulations, evolving member needs, and new business lines like DSNP-Medicare and Marketplace. Candidate Requirements Education/Certification Required: High School Diplom Preferred: Licensure Required: Preferred: ssociate's degree preferred

• Years of experience required
• Disqualifiers
• Best vs. average
• Performance indicators

Must haves: Strong oral, written, and problem-solving skills.

Nice to haves: 2+ years grievance or appeals, claims or related managed care experience.

Disqualifiers:

Performance indicators:

• Top 3 must-have hard skills
• Level of experience with each
• Stack-ranked by importance
• Candidate Review & Selection

1 Meeting deadlines in a fast-paced, compliance-driven environment 2 Familiarity with Medicaid, DSNP-Medicare, and/or Marketplace 3 Skilled use of Microsoft Office platforms (Word, Excel, Teams, Outlook, SharePoint)