In this production-focused role, you will analyze and resolve verbal and written claims and authorization appeals from healthcare providers, as well as pursue resolutions for formal grievances submitted by members. Working closely alongside Clinical Coordinators, Medical Directors, and Claims experts, you will ensure all disputes and appeals are reviewed with a high focus on accuracy, timeliness, and compliance standards. Operating from a remote setup in Ohio, you will process incoming documentation queues, prepare official response letters, and maintain complete records for individual appeals. If you bring strong problem-solving capabilities, excellent written communication skills, and a passion for supporting Medicaid, Medicare, or Marketplace members, this contract opportunity offers a supportive, team-oriented environment to apply and expand your skills.
salary: $22.99 - $23 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School
Responsibilities
Position Summary:
Analyze, research, and resolve verbal and written provider appeals, member grievances, and authorization disputes while maintaining compliance with state and organizational timelines.
Key Responsibilities:
- Gather, analyze, and process member and provider complaints, grievances, and claims/authorization appeals.
- Prepare formal response letters for member and provider grievances and appeals.
- Maintain accurate electronic files for individual appeals, tracking aging cases through production queues.
- Support pay-for-performance and HEDIS production initiatives through data entry, research, and outreach.
- Manage high-volume incoming documentation including copying, faxing, and scanning appeal records.
- High School Diploma or GED required; Associate's degree preferred.
- strong oral, written, problem-solving, and organizational skills.
- Ability to meet strict deadlines in a fast-paced, compliance-driven environment.
- Proficiency with Microsoft Office platforms (Word, Excel, Teams, Outlook, SharePoint).
- Dedicated, private remote workspace located in Ohio.
- Preferred: 2+ years of experience in claims, grievances, appeals, or managed care operations (Medicaid, DSNP-Medicare, or Marketplace).
Skills
Qualifications
Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
