In this key remote role, you will be responsible for monitoring incoming queues, reviewing incoming faxes and emails, and triaging Member and Provider workbaskets. Working a Pacific Time schedule (Monday through Friday, 8:00 AM – 5:00 PM PDT / 11:00 AM – 8:00 PM EST), you will evaluate case files, identify proper appeal classifications, eliminate duplicates, and route documentation to clinical, research, and escalations teams. You will maintain strict adherence to healthcare compliance guidelines to prevent processing delays and missed regulatory turnaround times. If you bring at least two years of Grievance and Appeals operations experience, sharp critical-thinking abilities, and strong data documentation accuracy, this 12-month contract assignment offers an ideal environment to apply your expertise.
salary: $23.24 - $23.25 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School
Responsibilities
Position Summary:
Serve as the primary intake point for Medicare appeals, triaging incoming faxes, emails, and workbasket queues while ensuring timely classification and routing to downstream teams.
Key Responsibilities:
- Monitor and process incoming appeals correspondence received via email, fax, and workbasket queues.
- Triage Member and Provider queues to determine accurate appeal classifications and priority levels.
- Identify and eliminate duplicate submissions while documenting complete case records.
- Route verified appeal files accurately to Clinical, Appeals Research, and Escalations teams.
- Adhere to strict regulatory deadlines and quality standards to prevent compliance delays.
- High School Diploma or equivalent required.
- Minimum 2 years of Grievance and Appeals (G&A) experience within managed care or healthcare operations.
- Working knowledge of Medicare appeal intake protocols, case processing, and regulatory turnaround times.
- Proficient computer and data entry skills with high attention to detail and accuracy.
- Dedicated remote workspace with availability to work Pacific Time business hours.
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.
