Appeals and Grievances Coordinator

Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for individuals facing the most complex and costly health conditions. We work across various specialties and primary care to connect the fragmented pieces of the healthcare system, ensuring that each person receives the same level of care and compassion we would desire for our loved ones. Evolent promotes a healthy work/life balance, offering flexibility to align work with personal lives and the autonomy to accomplish tasks effectively. We believe that employees perform best when supported in their personal lives and can bring their entire selves to work. This commitment to diversity and inclusion is fundamental to our business ethos. Join Evolent for the mission. Stay for the culture. What You'll Be Doing: As an Appeals and Grievances Coordinator, you will be a key resource for processing post-determination reviews and appeals following departmental policies, regulatory requirements, and client contractual obligations. Schedule: 10:30 am to 7 pm CST Collaboration Opportunities: The Specialty Appeals Team provides a meaningful avenue for candidates to impact health outcomes as part of a dedicated team focused on appeals and post-determination requests. Coordinators work closely with peers, senior coordinators, managers, clinicians, and numerous internal departments to ensure clear communication, knowledge sharing, and support across the organization. Our team thrives on collaboration, continuous learning, and a member-centric approach, helping to achieve better health outcomes for our members and the health plans we represent. Your Responsibilities: Review and process appeal requests received through various channels (phone, fax, email) adhering to regulatory requirements and health plan guidelines. Follow up with outbound calls as necessary. Conduct research and analyze case documentation, claims data, and medical records ensuring all case files are complete and contact providers for additional information as needed. Efficiently manage workload to move cases through the necessary stages promptly to meet service level agreements. Maintain accurate documentation and tracking in internal systems to streamline the appeal workflow, reporting, and compliance. Generate and verify the submission of acknowledgment letters for delegated appeals in line with regulatory standards. Achieve established productivity, quality, and timeliness guidelines set by the department. Qualifications: A high school diploma or GED. (Required) 3 years of experience as an Intake Coordinator or relevant experience in a health plan, managed care organization, or third-party administrator. (Required) 2 years of experience in processing appeals. (Preferred) Fluent in reading, writing, and speaking English with patients and providers. (Required) Able to adapt to changing situations and perform detailed work accurately. (Required) Proficient with computer systems and Windows PC applications, possessing strong keyboard and navigation skills. (Required) Proven ability to meet set goals while balancing workload and prioritizing tasks in a remote work setting. (Preferred) To ensure a secure hiring process, we implement several identity verification steps that include submission of a government-issued photo ID. Identity verification takes place during interviews, and final interviews may require in-person attendance. Candidates must undergo a thorough background check, in-person I-9 verification, and may be subject to drug screening before employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation at any stage will lead to immediate disqualification from consideration. Technical Requirements: All employees must have high-speed internet (over 10 Mbps) at home. For remote roles, employees should be able to connect directly to their internet router. These technical requirements may change as office locations reopen. Evolent is an equal opportunity employer, considering 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 information on this website, please contact for assistance. The expected base salary range for this position is competitive and includes a bonus component based on predetermined performance metrics. Evolent offers comprehensive benefits, including health insurance, to qualifying employees. Compensation decisions are based on the skills and experience required for the role and may vary above or below the stated amounts. If you don’t see your dream job listed, please share your contact information and resume, and we will reach out if a suitable fit arises!

Created: 2026-03-10