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Your Future Evolves Here

Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.

Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business.

Join Evolent for the mission. Stay for the culture.

What You’ll Be Doing:

The **Coordinator, Appeals and Grievances** at Evolent is responsible for reviewing and processing case requests, ensuring accurate documentation in CarePro, and preparing professional written correspondence in alignment with regulatory and health plan requirements. They have a broad knowledge of health care delivery, managed care regulations, and prior authorization experience. This role is distinct from other coordinator positions in that it is dedicated to case handling and documentation rather than phone and fax activities.

**Collaboration Opportunities** :

The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of a highly trained dedicated team focusing on health plan and provider requests. Coordinators collaborate daily with their peers, managers, clinicians and other internal departments when needed. This teamwork approach ensures consistent communication, knowledge sharing and support across the department, helping coordinators succeed in their roles. Our team values collaboration, continuous learning, and a member-centric approach, ensuring that every team member contributes to providing better health outcomes for our members and the health plans we serve.

What You Will Be Doing:

+ Review and process case requests including Consult P2Ps, BCBS TN Rad Onc IROs, Out of Network Benefit Denial packets, Overturns, and other special requests received via email, ensuring alignment with regulatory requirements, health plan guidelines and professional correspondence standards.

+ Manage workload effectively by moving cases through the appropriate stages in CarePro and other internal systems to meet service level agreements (SLAs).

+ Maintain accurate documentation and tracking in internal systems to support reporting, compliance and audits.

+ Meet established department guidelines related to productivity, quality and timeliness.

What You Bring:

+ A high school diploma or GED is required.

+ Minimum of 3 years’ experience in an Appeals and Grievances role or comparable administrative role within a health plan, managed care organization or third-party administrator is required.

+ Exceptional written communication skills, with the ability to draft clear, professional, and error free correspondence.

+ Proficiency with CarePro and related health plan applications used for case processing is preferred.

+ Familiarity with healthcare processes, benefit structures and regulatory guidelines (such as CMS and state requirements) sufficient to review case documentation and ensure correct handling.

+ Excellent attention to detail with demonstrated ability to research issues, follow established workflows, and determine next steps

+ Highly organized with the ability to prioritize, multitask, and adapt in a fast-paced environment while maintaining accuracy.

+ Demonstrated ability to research issues and determine next steps **.**

+ Experience with Windows, Excel and related computer applications, with strong keyboarding and system navigation skills.

To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration.

Technical Requirements:

We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.** **If you need reasonable accommodation to access the information provided on this website, please contact** **[email protected]** **for further assistance.

The expected base salary/wage range for this position is $22.00/hr. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.

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