Healthcare Data Entry Specialist Grievance & Appeals (Remote East Coast Preferred) Position Available In Capitol, Connecticut

Job Posting:

Healthcare Data Entry Specialist•Grievance & Appeals (Remote•East Coast Preferred)

Job Title:

Healthcare Data Entry Specialist•

Grievance & Appeals Job Category:

Data Entry Clerk Location:

Remote (East Coast candidates preferred)

Schedule:

Monday•Friday, 9:00 AM•5:00

PM EST Industry:

Health Insurance Pay Rate:

$20/hour Position Overview We are seeking a detail-oriented and experienced Healthcare Data Entry Specialist•Grievance & Appeals to support a critical project for a client of TEKsystems, a leading health insurance provider. This fully remote role is focused on helping the client address a significant backlog of over 10,000 appeals and grievances. If you have a background in healthcare data entry, claims processing, and customer service, this is your opportunity to make a meaningful impact in a high-visibility role. ????

Note:

While this is a remote position, candidates located on the East Coast are strongly preferred to align with the client’s business hours and team collaboration needs. ???? Preference will be given to candidates with prior experience in the healthcare industry. About the Client Our client is a major player in the health insurance industry, known for delivering high-quality, affordable care to millions of members. This role directly supports their mission to improve healthcare access and outcomes by ensuring timely and accurate processing of appeals and grievances.

Focus Area:

Grievance & Appeals This role is centered around the Grievance & Appeals process, a critical function in ensuring that members and providers receive fair and timely resolutions to their concerns. You will be responsible for reviewing, classifying, and processing complaints and appeals related to health insurance claims, services, and coverage decisions. Your work will directly impact member satisfaction, regulatory compliance, and the overall quality of care delivery. Key Responsibilities Review and process appeals and grievances submitted by members and providers. Ensure compliance with NCQA, CMS, state, and other regulatory standards. Accurately enter and manage data related to health insurance claims, grievances, and appeals. Communicate effectively with internal departments and external stakeholders to resolve issues. Conduct thorough investigations and prepare detailed case summaries for medical and administrative review. Draft clear and accurate written responses to member and provider correspondence. Monitor and manage personal worklists to ensure timely resolution of cases. Identify process improvement opportunities and provide feedback to management. Must-Have Skills Data Entry Health Insurance Knowledge Grievances & Appeals Processing Claims Management Medical Records Handling Medical Terminology Patient Access or Service Coordination Nice-to-Have Skills Experience with Coventiti or CAGE systems Managed Care or Compliance Background Familiarity with NCQA and CMS Guidelines Qualifications 3+ years of relevant professional experience in healthcare or insurance Strong written and verbal communication skills Proficiency in Microsoft Office (Word, Excel, Outlook) Excellent organizational, analytical, and problem-solving abilities Ability to work independently in a fast-paced, remote environment