Job Details

Grievance And Appeal Intake Specialist

TekSystems is currently hiring for a fully remote Grievance and Appeal Intake Specialist! This position must be near or local to the DMV area! Must have: any medical administrative/data entry experience, or anything related to grievance and appeal intake specialist background!

Job Profile Summary: The Grievance and Appeal Intake Specialist supports the Appeals and Grievance (A&G) function by handling all administrative functions of the A&G process including intake, logging, tracking, and status follow-up of all appeal and grievance requests. Work involves a review of recorded calls relating to appeals and grievances and prepares written transcripts, as appropriate. Performs other duties as assigned.

Duties and Responsibilities:

• Effectively routes intake/triage for fulfillment, independently evaluates information to determine correct categorization, and performs timely data entry to support follow-up inquiries received in our Service Center.
• Tracks all open A&G files to ensure that responses are completed within the timeframe required by alliance performance requirements, law, regulation, policy, or other requirement.
• Assists with the communication of A&G determinations by preparing template letters for members/providers, prepare weekly department activity reports and monthly production reporting, and scan A&G files for record retention.
• Identifies potential issues when preparing and reviewing reports for discussion with department leadership.
• Creates and maintains electronic and hard copy paper files in accordance with all regulatory requirements.
• Perform other duties as assigned.

Skills:

• Self-directed and strong organizational skills to meet departmental goals with minimal supervision.
• Ability to clearly interpret written inquiries and complaints and produce written documents.
• Able to demonstrate excellent business writing and comprehension skills to include but not limited to spelling, grammar, punctuation.
• Strong verbal communication skills.
• Demonstrated knowledge of Microsoft Office Suite.

Experience:

• Minimum 2+ years of experience in customer service within a dental, medical or Managed Care industry.

Education and Certifications:

• High school diploma or equivalent.

Work Environment:

This job operates in a professional office environment. This role routinely uses standard office equipment such as laptops, smart phones, photocopiers/scanners, shredders, and filing cabinets.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands to finger, handle, or feel; and reach with hands and arms.

Pay and Benefits:

The pay range for this position is $17.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: medical, dental & vision; critical illness, accident, and hospital; 401(k) retirement plan pre-tax and Roth post-tax contributions available; life insurance (voluntary life & AD&D for the employee and dependents); short and long-term disability; health spending account (HSA); transportation benefits; employee assistance program; time off/leave (PTO, vacation or sick leave).

Workplace Type:

This is a fully remote position.

Application Deadline:

This position is anticipated to close on Aug 6, 2025.

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe, and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.