Specialist, Admin Complaints, Grievances & Appeals

Location: Fully remote for candidates residing in Arizona, Texas, Florida, or Georgia. Future work models may include hybrid presence at the hub office associated with the candidate's metro area.

Salary: $46,368–$60,858 per year in California, Connecticut, New Jersey, New York, and Washington; $41,731–$54,772 per year in other locations.

Company

hirify.global is a health insurance company built around a full-stack technology platform and a focus on serving members.

What you will do

• Manage complex or escalated administrative grievances and appeals from members and providers.
• Investigate cases by analyzing internal data, call logs, correspondence, claims, prior authorizations, and system adjudication edits.
• Collaborate with Member Services, Eligibility & Benefits, Claims, and other internal departments to resolve cases.
• Determine fair, compliant resolution strategies and escalate cases to leadership when needed.
• Draft formal resolution letters and maintain complete case files and audit trails.
• Manage case timelines to meet all federal and state-mandated deadlines.

Requirements

• 1+ years of professional experience in a regulated industry such as healthcare, insurance, or finance.
• 1+ years of independently managing demanding caseloads through intake, investigation, resolution, and final documentation.
• 1+ years of experience managing escalated customer, member, or provider cases.
• 1+ years of experience drafting and issuing formal written communications to members and providers.
• 1+ years of experience working in a structured, workflow-driven environment.

Nice to have

• Bachelor's degree.
• Experience in healthcare administration.
• Involvement in process improvement or quality programs.
• Bilingual proficiency in English and Spanish.

Culture & Benefits

• Medical, dental, and vision benefits.
• 11 paid holidays, paid sick time, and paid parental leave.
• 401(k) plan participation, life and disability insurance, and paid wellness time.
• Monthly vacation accrual at a rate of 15 days per year.
• Equal-opportunity environment focused on belonging and support.