New

Remote Appeals And Grievances Claims Coordinator

TEKsystems
$22.00 / hr
life insurance, sick time, 401(k), retirement plan
United States, Texas, Dallas
Nov 06, 2025
IMMEDIATE OPENINGS FOR MEMBER APPEALS SPECIALIST MUST HAVE PRIOR APPEALS AND GRIEVANCES EXPERIENCE 100% REMOTE, EQUIPEMENT PROVIDED MONDAY - FRIDAY 8AM-5PM EST $23/HR Qualifications: * 3 years of medical claims experience/appeals + grievances experience * Microsoft Office proficient Member Appeals Specialist duties include: * case management of the appeal starting at assignment of the case from the AG Coordinator, * evaluating timeliness of the appeal, eligibility of the member, * issuing an acknowledgement letter using a template pre-loaded in the system of record, making edits necessary for the case at hand * reviewing the appeal request to determine if additional medical records are needed, and whether an Appointment of Rep form is needed, * making any necessary verbal outreach to obtain documents / obtain answers to questions * collaborating with team members for case steps as needed / required by workflow (Specialists, Supervisor, Quality Nurses, Medical Directors, Pharmacy Team) * drafting appeal decision notices using template language and reference materials to ensure compliance * managing a case load of approximately 40 cases at a time and staying timely in accordance with our regulatory guidelines * use of our systems in processing work such as Pharmacy Benefit Management (PBM) with Express Scripts, Inc (ESI), referring to Facets when necessary, Outlook for email, Teams for chat/meetings, Zoom for team meetings, Avaya for phone calls, etc. Job Type & Location This is a Contract to Hire position based out of Dallas, TX. Pay and Benefits The pay range for this position is $22.00 - $22.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: * Medical, dental & vision * Critical Illness, Accident, and Hospital * 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available * Life Insurance (Voluntary Life & AD&D for the employee and dependents) * Short and long-term disability * Health Spending Account (HSA) * Transportation benefits * Employee Assistance Program * Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully onsite position in Dallas,TX. Application Deadline This position is anticipated to close on Nov 19, 2025. h4>About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. About TEKsystems and TEKsystems Global Services We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.