• Appeals And Grievance Specialist

    Actalent (Dallas, TX)


    Job Title: Specialist, Appeals & GrievancesJob Summary:

    Responsible for reviewing and resolving member and provider complaints and communicating resolutions.

    Key Responsibilities:

    + Conduct comprehensive research and resolve appeals, disputes, grievances, and complaints.

    + Use internal systems to determine outcomes of claims appeals and grievances.

    + Review medical records and billing details to formulate conclusions.

    + Ensure timely and appropriate responses per state.

    + Prepare summaries and correspondence; document findings and trends.

    + Communicate with members and providers via written and verbal channels.

    + Apply contract language and benefits knowledge to case reviews.

    Qualifications:

    + Education: High School Diploma or equivalent

    + Experience: Minimum 2 years in managed care (call center, appeals, or claims)

    + Experience in health claims processing, coordination of benefits, and eligibility

    + Familiarity with Medicaid and Medicare regulations

    + Strong written and verbal communication skills

    + Ability to work fully remote, equipment provided

    Pay and Benefits

    The pay range for this position is $18.00 - $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 remote position.

     

    Application Deadline

     

    This position is anticipated to close on Oct 17, 2025.

    About Actalent

    Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

     

    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.

     

    If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email [email protected] (%[email protected]) for other accommodation options.