Grievances & Appeals Expedited Case Representative

Location: Remote nationwide in the United States; occasional travel to hirify.global offices may be required for training or meetings. Training runs Monday through Friday for approximately four weeks, between 8:00 am and 5:00 pm Eastern Time. After training, the required schedule is Tuesday through Saturday, 11:30 am to 8:00 pm Eastern Time, with alternating holidays and overtime as needed.

Salary: $43,000–$56,200 per year.

Company

hirify.global is a U.S. healthcare and health insurance company serving members through Medicare, Medicaid, insurance, and healthcare services.

What you will do

• Review and evaluate several expedited Medicaid and AIP dual-eligible appeals cases per hour.
• Manage cases from assignment through resolution by analyzing clinical documentation and collaborating with business partners.
• Assess urgency, process cases chronologically, and resolve them within strict turnaround times, typically 24 hours.
• Make outbound calls to members and providers to communicate outcomes, request documentation, clarify details, and resolve outstanding issues.
• Monitor multiple workstreams, follow changing workflows, communicate process gaps, and seek guidance when needed.

Requirements

• At least one year of customer service experience.
• At least one year of experience in healthcare or the medical field.
• Experience working to production goals and performance metrics.
• Intermediate proficiency with Microsoft Word, Excel, Outlook, and Teams, plus comfort working across multiple software systems.
• Ability to manage a high-volume, rapidly changing workload, shifting priorities, and new processes independently.
• Ability to work the required U.S. Eastern Time schedule and maintain a dedicated home workspace protecting member PHI and HIPAA information.

Nice to have

• Inbound call center or related customer service experience.
• Grievances and appeals, medical authorization, Medicare, or Medicaid experience.
• Bilingual English and Spanish communication skills.
• Knowledge of medical terminology.

Culture & Benefits

• Full-time schedule of 40 hours per week.
• Virtual training begins on the first day and attendance is required; time off is not allowed during training and is limited during the first 180 days.
• Home internet must provide at least 25 Mbps download and 10 Mbps upload speeds.
• Benefits include medical, dental, and vision coverage, 401(k), paid time off, holidays, parental and caregiver leave, disability coverage, and life insurance.