Grievance Specialist (Medicare Appeals and Grievances)

Location: Remote USA

Salary: $23–$26 per hour

Company

hirify.global is a healthcare company founded in 2017 that combines an integrated care platform, advanced data and AI access, and clinical and service experiences to improve the health and well-being of older Americans.

What you will do

• Investigate member grievances by reviewing case details, member records, and applicable policies and procedures.
• Triage, categorize, route, and resolve grievances accurately within regulatory and departmental timelines.
• Communicate with members through written correspondence and telephone contact while handling complex or sensitive concerns with empathy.
• Document cases and enter data accurately across multiple systems.
• Collaborate with internal partners to gather information, escalate cases when needed, and complete thorough resolutions.
• Identify recurring themes, root causes, and opportunities to improve processes and the member experience.

Requirements

• Experience with Medicare Advantage appeals and grievances.
• Strong attention to detail, data accuracy, organization, and time management.
• Excellent customer service, conflict resolution, written communication, and verbal communication skills.
• Ability to explain complex information clearly and work independently and collaboratively.
• Ability to adapt to changing regulations, priorities, and case volumes.

Nice to have

• Bachelor’s degree or equivalent experience in healthcare, conflict resolution, or a related field.
• Working knowledge of insurance products, policies, procedures, and claims processes.
• Strong investigative, analytical, and problem-solving skills.
• Experience escalating cases and collaborating with internal stakeholders.
• Comfort using multiple computer and documentation platforms.

Culture & Benefits

• Remote work environment focused on member advocacy, continuous learning, collaboration, and adaptability.
• Employer-sponsored health, dental, and vision plans with low or no premium.
• Generous paid time off and a parental leave program.
• $100 monthly mobile or internet stipend.
• Stock options for all employees and bonus eligibility for applicable roles.
• 401(k) program.