Appeals and Grievance Specialist - Work from Home

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries. Job title: Appeals and Grievance Specialist - Work from Home Job Description: BroadPath, a Sagility Company, is hiring experienced Appeals and Grievance Specialists to join our remote team! The Appeals and Grievance Specialist reviews, investigates, and resolves complaints, grievances, and appeals submitted by members and providers. This role serves as a key point of contact throughout the resolution process while ensuring cases are handled accurately, thoroughly, and in compliance with applicable requirements. Schedules, pay rates, and program details may vary based on business needs and client assignment. Compensation Highlights Base Pay: Starting at $18 per hour Pay frequency: Weekly pay Schedule Highlights Schedules can fall between the hours of Monday-Friday, 8:00 AM - 5:00 PM Pacific Time, and will be assigned based on business needs Responsibilities Manage and resolve complaints, grievances, and appeals from members and providers Serve as the primary contact throughout the investigation and resolution process Send acknowledgments and provide clear education on the grievance and appeal process Gather relevant information and research case details to determine an appropriate resolution Conduct fair, accurate, and timely case investigations Communicate resolutions to appropriate internal and external parties Ensure all required documentation is completed and maintained Follow established policies, procedures, and regulatory requirements Maintain productivity and quality standards in a structured workflow environment Quali