Do you have a keen eye for detail and a passion for fairness? Versant Health is hiring a Grievance & Appeal Specialist to investigate and resolve member complaints, appeals, and inquiries while ensuring regulatory compliance and high-quality customer outcomes.
About Versant Health
Versant Health is one of the nation’s leading managed vision care providers, serving millions of members nationwide. Our mission is to help people enjoy the wonders of sight through healthy eyes. Associates enjoy competitive pay, health and dental insurance, tuition reimbursement, a 401(k) with company match, pet insurance, and no-cost vision coverage for you and your dependents. We’re also committed to professional growth, offering development opportunities across all career stages.
Schedule
- Full-time
- Remote (with preference for candidates in Albany, NY)
- Standard weekday hours with flexibility as business needs require
What You’ll Do
- Investigate and document grievances, complaints, and appeals in compliance with state, federal, and NCQA requirements
- Research case details, review supporting documents, and assemble complete case files
- Document all cases in the appeals management system to meet CMS reporting and validation standards
- Communicate outcomes clearly and professionally to members, providers, and clients
- Coordinate with internal compliance, operations, and clinical teams as needed
- Ensure timely and accurate appeal effectuation
- Participate in process improvement initiatives and recommend strategies for efficiency
- Develop and update procedures, training materials, and quality standards for the appeals process
- Prepare oral and written responses to executive, legislative, or state inquiries
- Support cross-functional projects and change initiatives as assigned
What You Need
- High school diploma or GED required
- 2+ years of grievance, appeals, or related healthcare/insurance experience
- Strong research, analytical, and documentation skills
- Excellent written and verbal communication skills
- Ability to manage sensitive and confidential information in compliance with HIPAA
- Strong organizational skills with the ability to work independently and within a team
Benefits
- $24.04/hour starting rate
- Full health, dental, and vision coverage (vision free for you and dependents)
- Tuition reimbursement
- 401(k) with company match
- Pet insurance and additional perks
- Career advancement opportunities within a supportive, inclusive environment
Join a team where your work directly impacts member experiences and ensures fair, timely outcomes.
Bring your expertise, and let’s make a difference together.
Happy Hunting,
~Two Chicks…