Grievance & Appeals Coordinator


Strategic Staffing Solutions


Strategic Staffing Solutions (S3) is currently looking for a Grievance & Appeals Coordinator for a contract opening with one of our largest clients located in Detroit, MI

Role Title: Grievance &Appeals Coordinator

Location:  Detroit, MI (Fully Remote in Michigan)

Duration: 6+ months (Possible conversion to LTC or FTE)

Role Type: W2 Contract Engagement

Pay Rate: $30-32/hour

*This is a remote role however candidates MUST reside in the state of Michigan

*Training is onsite in downtown Detroit

Job Description

Process grievances and organization determinations, analyze, research, and provide comprehensive responses in accordance with established regulatory and accreditation guidelines.  Contact customers to gather information and communicate disposition of case. Conduct pertinent research in order to evaluate, respond to, and finalize case. Familiar with standard concepts, practices, and procedures for analyzing, interpreting data and applying contract and regulatory provisions.


  • High School Diploma or GED required. Bachelor’s Degree in Health Care Administration, English, Communications, or related field preferred.
  • Two (2) years customer service experience required.
  • Two (2) years health insurance experience and familiarity with health insurance state and federal regulations preferred.
  • Strong project management skills preferred including management of personal inventory.
  • Strong analytical, critical thinking, organizational, time management and problem resolution skills.
  • Excellent verbal and written communication skills.
  • Strong PC applications (i.e. Microsoft Excel, Word, and Outlook).
  • High regard for protecting confidentiality of corporate information.
  • Proven ability to foster and maintain open, collaborative, and constructive relationships within internal, external and leadership to achieve departmental and corporate results.
  • Ability to apply policies and procedures to arrive at accurate conclusions.
  • Ability to analyze, interpret, apply reason and logic, conduct research structure a clear and thorough response.
  • Ability to quickly learn and navigate diverse products and information systems.
  • Other related skills and/or abilities may be required to perform this job.
  • An understanding of MA servicing structure related to grievance and appeals or experience in claims with the ability to apply EOC research in prepping cases preferred.
  • Previous experience with Health Insurance preferred.
  • Demonstrates one can handle multiple tasks/projects concurrently with minimal supervision

Medicare Advantage

  • Accountable for CMS Chapter 13, CMS Audit Compliance and Star Quality Measures: a. Member rights, b. Timely decisions about appeals, c. Fairness of the health plan’s appeal decisions based on an independent reviewer
  • Data entry accuracy is required.
  • Full understanding of Medicare Advantage servicing environment is preferred.

The S3 Difference

The global mission of S3 is to build trusting relationships and deliver solutions that positively impact our customers, our consultants, and our communities.  The four pillars of our company are to:

  • Set the bar high for what a company should do
  • Create jobs
  • Offer people an opportunity to succeed and change their station in life
  • Improve the communities where we live and work through volunteering and charitable giving

As an S3 employee, you’re eligible for a full benefits package that may include:

  • Medical Insurance
  • Dental Insurance
  • Vision Insurance
  • 401(k) Plan
  • Vacation Package
  • Life & Disability Insurance Plans
  • Flexible Spending Accounts
  • Tuition Reimbursement

To apply: Please email your resume in Word Format to Bob Cromer at:


Job ID: JOB-232790
Publish Date: 01 Dec 2023

Tagged as: Grievance & Appeals Coordinator