The Appeals and Grievance Triage Administrator is a dual-department role responsible for the initial intake, investigation, and assignment of all member and provider disputes. Acting as a critical liaison between our client, its members, and contracted providers, the Administrator ensures all cases are triaged accurately and processed in strict alignment with CMS, NCQA, and state regulatory standards.
salary: $21 - $22 per hour shift: First work hours: 8 AM - 4 PM education: High School
Responsibilities
Investigation & Case Management:
Act as the initial point of contact for members and providers. This involves gathering evidence, educating parties on the process, and investigating issues like claim denials, filing limits, and retrospective referrals. Administrative Operations:
Manage high-volume intake via mail, fax, and email. Responsible for case assignment, maintaining databases, and ensuring all necessary legal authorizations (e.g., Medical Record Releases) are obtained. Compliance & Reporting:
Ensure all processes strictly adhere to state and federal regulations (CMS, MassHealth, NCQA). Produce appeal determination letters and analyze data to assist management with monthly reporting. Hearing Support:
Provide administrative backing for the Board of Hearings (BOH), including the preparation and tracking of hearing packets and decisions. Office Presence:
While supporting remote workflows, this role requires traveling to the
Worcester, MA
office several times per month to handle physical mailings and letter production.
Skills
Telephone Etiquette Active Listening Follow-up Basic Computer Skills Customer Service Customer Relations Healthcare Typing Skills
Qualifications
Years of experience: 3 years Experience level: Experienced
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.
salary: $21 - $22 per hour shift: First work hours: 8 AM - 4 PM education: High School
Responsibilities
Investigation & Case Management:
Act as the initial point of contact for members and providers. This involves gathering evidence, educating parties on the process, and investigating issues like claim denials, filing limits, and retrospective referrals. Administrative Operations:
Manage high-volume intake via mail, fax, and email. Responsible for case assignment, maintaining databases, and ensuring all necessary legal authorizations (e.g., Medical Record Releases) are obtained. Compliance & Reporting:
Ensure all processes strictly adhere to state and federal regulations (CMS, MassHealth, NCQA). Produce appeal determination letters and analyze data to assist management with monthly reporting. Hearing Support:
Provide administrative backing for the Board of Hearings (BOH), including the preparation and tracking of hearing packets and decisions. Office Presence:
While supporting remote workflows, this role requires traveling to the
Worcester, MA
office several times per month to handle physical mailings and letter production.
Skills
Telephone Etiquette Active Listening Follow-up Basic Computer Skills Customer Service Customer Relations Healthcare Typing Skills
Qualifications
Years of experience: 3 years Experience level: Experienced
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.