(REMOTE) Appeals and Grievance Representative (GA, Powder Springs)

Locations: Alabama, Florida, Georgia, Illinois, Kentucky, Maryland, North Carolina, South Carolina, Tennessee, Texas, Virginia, and Washington State

Position Type: Full-Time | Remote

Pay Rate: $17.75/hour base pay plus an additional $5.36/hour applied toward health and welfare benefits or retirement (depending on benefit election).If health benefits are not needed (candidate has TRICARE, VA, or spouse provided health coverage) the $5.36 per hour is placed in a 401(a)-tax deferred account where 3% of the funds are matched by the company. If the candidate needs health, vision, dental insurance from the company, the $5.36 per hour pay is applied to cover health benefit options selected.

Position Summary

Widescope Consulting and Contracting is urgently hiring experienced Appeals and Grieveance Representatives to support a remote healthcare initiative. In this role, you will be responsible for reviewing, researching, and resolving member and provider appeals and grievances with accuracy and professionalism. We are seeking candidates who can start right away and bring strong claims experience, problem-solving skills, and attention to detail.

Key Responsibilities

• Review and resolve appeal and grievance cases
• Research underlying issues and apply appropriate policy guidelines (CMS, TRICARE)
• Communicate decisions clearly with internal teams and external parties
• Maintain organized, accurate documentation for each case
• Work independently in a fast-paced, non-scripted environment

Required Qualifications

• High School Diploma / GED (or higher)
• 2+ years of healthcare claims benefits experience (including denial research)
• 1+ year of customer service experience
• 1+ year of claims appeal experience
• Proficiency in Microsoft Word and Excel

Preferred Skills

• Familiarity with TRICARE or Medicare (CMS) policies and procedures
• Strong time managment and analytical thinking
• Excellent verbal and written communication skills

Remote Work Requirements

• A quiet, dedicated home workspace free of distractions
• Reliable high-speed internet (minimum 50Mbps down / 7 Mbps up)
• Wired internet connection (LAN) preferred
• Ability to perform basic troubleshooting with phone support from tech team
• Company-provided equipment (computer, monitors, webcam, headset, cables) and support.

Apply now! We are hiring immediately and reviewing qualified candidates on a rolling basis.