CenterWell Certified Healthcare Corp.Hiring

Grievances and Appeals Representative

  • Remote, worldwide
  • Full-time
  • Mid-level
  • Posted 2 days ago
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In one line

Grievances and Appeals Representative is a mid-level full-time remote role open to candidates worldwide at a large health insurance company.

About the role

The team reviews clinical documents to work out whether a complaint, appeal or other request is warranted, then issues the final decision. Work is measured against production and quality targets, with some independence in how you order your tasks.

At a glance

Pay
Not stated in the posting
Remote scope
Remote, worldwide
Seniority
Mid-level
Employment
Full-time
Working hours
Shifts between 7 a.m. and 7 p.m. Eastern, any day of the wee
Skills
PaHub, Medical terminology, Data entry
Posted
27 Oct 2026
Last checked
28 Oct 2026

What you will do

  • Take calls from members and provider offices and look into their issues
  • Review clinical paperwork and decide if a grievance or appeal should go ahead
  • Resolve claims questions for Medicare Part B pharmacy, dual eligible plans and diabetic supplies
  • Keep up with production and quality targets while handling a high volume of documents

What they look for

  • A year or more in customer service, such as a call center or retail
  • Background in healthcare, pharmacy or another medical field
  • A year or more handling grievances and appeals
  • Experience in a setting with production and quality metrics
  • Solid data entry and Microsoft Word and Excel

Nice to have

  • Prior work processing medical claims, ideally Part B pharmacy claims
  • Knowledge of Medicare or dual eligible plans and medical terminology
  • Experience with PaHub and with working from home

How Keywordise applies for you

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Claude

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Connector URL
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Connector URL
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Message for Muse
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Muse is available in the US only for now.

Prompt
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How to connect

Questions about this job

Is this job fully remote, and from where?

The posting lists it as remote with no single country named, so candidates from different countries can apply. On hours, the posting says: Shifts between 7 a.m. and 7 p.m. Eastern, any day of the wee.

What does this job pay?

No pay range is stated in the posting.

What experience is needed?

It is a mid-level role. The posting asks for: a year or more in customer service, such as a call center or retail; background in healthcare, pharmacy or another medical field; a year or more handling grievances and appeals. Skills it names include PaHub, Medical terminology, Data entry.

How do I apply with Keywordise AI?

Select Apply with Keywordise AI, sign up and upload your CV. Keywordise writes a CV and a cover letter for this job from your real experience and applies for you. The 7-day free trial needs no card.

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CenterWell Certified Healthcare Corp.Remote, worldwide
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