Grievances & Appeals Rep - Medicaid Intake

Job Listing ID:

4496824

Job Title:

Grievances & Appeals Rep -

Medicaid Intake Application Deadline:

Open Until Filled

Job Location:

Salem

Date Posted:

05/22/2026

Hours Worked Per Week:

Not Provided Shift:

Not Provided Duration of Job:

Either Full or Part Time, more than 6 months You may contact this employer directly. (Obtain the contact information to print or add to your jobs.)

Job Summary:

Become a part of our caring community You will report to the Grievances & Appeals Supervisor and be part of the Resolution Team. The Grievances & Appeals Representative 2 triages Medicaid and AIP (dual) cases and reviews clinical documentation to determine if a grievance or appeal is warranted. This is an extremely high-volume, fast-paced role, with the responsibility of moving several cases per hour. We ask that you have proactive queue management, attention to changing processes, experience handling support requests across multiple workstreams, and effective communication with managers and team leads. As a Grievances & Appeals Representative 2, you will: Review and evaluate several cases per hour by identifying valid Medicaid and AIP (dual) grievances and appeals cases. Assess case priorities while processing in chronological order, ensuring you handle all cases within strict turnaround times ranging from 24 hours to 5 days. Conduct analytic reviews of clinical documentation to determine case validity, including investigative work to find the denial. Make outbound calls to members or providers to request documentation, clarify case details or address outstanding issues. Review and code cases, routing them to the appropriate queue while collaborating with leadership to maintain accuracy. Stay current with frequently changing mentor documents and workflows. Monitor multiple workstreams and adapt quickly to process changes. Communicate gaps or issues and seek guidance as needed. Use your skills to make an impact

ALL CANDIDATES

PLEASE

INCLUDE A CURRENT RESUME FOR CONSIDERATION.

Required Qualifications:

Must reside in the central or eastern time zone 2+ years of customer service experience Proficient in Microsoft Word and Excel, as candidate will need to use Word letter templates and Excel for case tracking Experience in production environments and consistently meeting performance metrics Experience managing a high-volume workload across multiple software systems, ensuring thoroughly documented outcomes and minimal data entry error rates

Preferred Qualifications:

Associate or bachelor's degree Prior Grievances and Appeals experience Experience in medical claims processing Previous inbound call center or related customer service experience Knowledge of medical terminology Prior experience with Medicaid or Medicare Experience with

CAS, CRM, CGX, Pahub, RxNova, or Service Read Only Additional Information Required Training Schedule:

8:00 am - 4:30 pm Eastern, Monday through Friday, for two to four weeks.

Required Work Schedule:

11:00 am - 7:30 pm in your time zone (Central/Eastern), Tuesday through Saturday, with overtime as needed. Must commit to working within the department for a minimum of eighteen (18) months. Hours are subject to change based on business need.

Work-at-Home Information:

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state...

Job Classification:

Customer Service Representatives Access our statewide or regional occupation report for more information about wages, employment outlooks, skills, training programs, related occupations, and more. Compensation

Salary:

Not Provided Job Requirements

Experience Required:

 See Job Summary

Education Required:

None

Minimum Age:

N/A Gender:

N/A