Appeals and Grievances Specialist (Health Insurance)

Location: Remote

Salary: $65,000–$75,000 per year, plus bonus opportunity and equity package

Company

hirify.global is a health insurance company focused on making healthcare more affordable, accessible, personalized, and transparent in the United States.

What you will do

• Manage member and provider appeals and grievances from intake and triage through resolution.
• Investigate claims history, benefit determinations, clinical documentation, and prior correspondence.
• Apply plan documents, state and federal regulations, and company policy to prepare accurate determinations.
• Draft clear, compliant resolution letters and communications for members and providers.
• Track case deadlines, maintain accurate records, and coordinate with Claims, Clinical, Provider Relations, Legal, QA, and leadership.
• Identify escalation risks, recurring issues, and opportunities to improve processes, SOPs, and knowledge-base content.

Requirements

• Bachelor’s degree in healthcare administration, business, public health, or a related field.
• At least 3 years of experience in appeals and grievances, claims adjudication, utilization review, or related health insurance operations.
• Working knowledge of health insurance requirements, including state DOI requirements, ERISA, and ACA regulations as applicable.
• Strong analytical skills and the ability to interpret claims data, plan documents, and clinical notes.
• Excellent written communication skills, with the ability to explain complex determinations in plain, empathetic language.
• Ability to manage a caseload independently, meet strict deadlines, and work across systems and teams.

Nice to have

• Experience with Genesys Cloud, Salesforce, or similar case management and CRM platforms.
• Familiarity with Medicare Advantage or ACA marketplace appeals processes.
• Experience in a fast-growing or startup health insurance environment.

Culture & Benefits

• Remote work at a rapidly growing, mission-driven healthcare company.
• Medical, dental, and vision benefits.
• 401(k) retirement plan.
• Paid vacation and company holidays.
• Bonus opportunity and equity package.