Grievances & Appeals Professional

Location: Remote Wisconsin; Monday–Friday, between 8:00 am and 5:00 pm CST. Occasional travel to hirify.global offices for training or meetings may be required.

Salary: $59,300–$80,900 per year, plus eligibility for a bonus incentive plan.

Company

hirify.global is a U.S. healthcare and health insurance company serving Medicare and Medicaid members, families, individuals, and communities.

What you will do

• Review, research, and resolve formal grievances, appeals, informal complaints, and member concerns within applicable deadlines.
• Investigate member and practitioner issues by gathering information, reviewing case details, and identifying next steps.
• Collaborate with clinical reviewers and internal partners to evaluate documentation and support final determinations.
• Support conflict resolution and mediation in a respectful, solution-focused manner.
• Document findings, actions, and outcomes while maintaining confidentiality and protecting member health information.
• Identify recurring issues and process improvements that may enhance the member experience.

Requirements

• Bachelor’s degree.
• 3+ years of experience in social work, human services, healthcare, medical services, or a related field.
• 2+ years of experience using Microsoft Word and Excel to organize, track, and manipulate data.
• Ability to work independently, manage multiple cases, and meet deadlines, turnaround times, and compliance requirements.
• Ability to work remotely from Wisconsin during CST business hours is required.
• A dedicated, interruption-free workspace and internet service with at least 25 Mbps download and 10 Mbps upload are required.

Nice to have

• Experience with grievance and appeals procedures or case resolution.
• Experience working with Medicaid or Medicare populations.
• Experience processing medical claims or applying medical terminology.
• Experience supporting people with intellectual or developmental disabilities, physical disabilities, or frail older adults.

Culture & Benefits

• Remote work-from-home arrangement with occasional travel for training or meetings.
• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, company and personal holidays, and paid parental and caregiver leave.
• Short- and long-term disability coverage, life insurance, and wellness-focused benefits.