bluedoor data·Job Postings API·bluedoor.sh ↗

Home › Companies › 8b6d34a2 662b 4ceb Abfc 528d20745f96 19000101 000001 › Appeals & Grievances Coordinator

Appeals & Grievances Coordinator

8b6d34a2 662b 4ceb Abfc 528d20745f96 19000101 000001 · Mass State, Southborough, MA, US, Southborough, MA · Active · $55,000–$75,000 / year · ADP Workforce Now Recruiting

Job facts

FieldValue
Company8b6d34a2 662b 4ceb Abfc 528d20745f96 19000101 000001
TitleAppeals & Grievances Coordinator
Normalized title-
Department / team-
LocationMass State, MA, United States
Work model-
Employment typeFull Time
Salary$55,000–$75,000 / year
Statusactive
ATS providerADP Workforce Now Recruiting
Posted / first seen2026-06-03 / 2026-06-04
Changed / last seen2026-06-06 / 2026-06-06

Related slices

PageWhat it containsOpen
Company jobsActive postings from 8b6d34a2 662b 4ceb Abfc 528d20745f96 19000101 000001.Open
Company breakdownsRole, location, ATS, and work model facets for this company.Open
ATS provider jobsActive postings observed through ADP Workforce Now Recruiting.Open
Provider filtered searchThe same provider as a filtered job collection.Open
City jobsActive postings in Mass State.Open
Lifecycle eventsOpen, update, close, and reopen events for this posting.Open
Original postingCanonical source or apply URL captured from the ATS.Open

Linked records

Company8b6d34a2 662b 4ceb Abfc 528d20745f96 19000101 000001
Sourcee0ea2e22-8f53-4793-ba61-fd2c0e7555a2
ATS providerADP Workforce Now Recruiting

Description

Job Summary nirvanaHealth is rebuilding the payer enterprise on a digital workforce. Our cloud-native Aria platform delivers payer administrative and care-continuum functions as Transaction-as-a-Service (TaaS) — combining robotic process automation, machine learning, and agentic AI to execute the thousands of transactional functions that currently consume payer operating margin. We operate across Medicare Advantage, Medicaid, Commercial, ASO, and ACA lines of business. As an Appeals & Grievances (A&G) Coordinator, you will help support the intake, review, and resolution of member and provider appeals and grievances while ensuring cases are handled accurately, compliantly, and within CMS-mandated timelines. In this role, you will work closely with the VP of Health Services and partner across clinical, compliance, operations, and customer service teams while using Aria’s A&G module and emerging AI-assisted workflows to support member rights and deliver audit-ready outcomes. This position also supports delegated operations, requiring adaptability across process variations while maintaining consistent regulatory compliance. Job Responsibilities Manage cases end-to-end — Receive, document, investigate, and resolve member and provider appeals (Part C and Part D) and grievances submitted via phone, fax, email, mail, or portal. Track and enforce CMS timeliness. Draft member-facing communications — Draft acknowledgment and resolution letters that are clear, empathetic, and fully compliant with CMS, state, and accreditation (NCQA/URAC) requirements. Collaborate cross-functionally — Partner with Medical Directors, Compliance, Pharmacy, Utilization Management, Customer Service, and external review bodies to build complete case folders and drive meaningful outcomes. Support delegated operations — Execute A&G processes across delegated environments, maintaining process variations where needed while adhering to standard operating procedures. Prepare evidence for external review — Compile and organize case files for IRE auto-forwards and external audit bodies. Leverage emerging tools — In addition to MS Office and other Windows-based tools, utilize emerging tools to drive quality and productivity. Surface insights and support reporting — Compile data for regulatory reporting, help identify trends, and contribute to quality improvement initiatives. Qualifications Category Required Preferred Education — Bachelor's degree or equivalent experience Experience 1–3 years of related experience Hands-on A&G case management, prior auth, or compliance/quality experience; Medicare Advantage, Medicaid, or Commercial plan environment Regulatory Knowledge Working familiarity with CMS guidance, Medicare Part C & D regulations, member rights under 42 CFR §§422/423 NCQA and/or URAC accreditation standards; Massachusetts state requirements (MassHealth, DOI, Office of Patient Protection) Writing & Communication Strong professional writing skills — you will draft acknowledgment, resolution, and determination letters daily; effective verbal communication with members, providers, clinical staff, and external agencies — Tools & Technology Microsoft Office (Excel, Word, Outlook); comfort with case management and tracking systems Healthcare payer platform experience Core Competencies Detail orientation under regulatory deadlines; critical thinking in case investigation; high-volume caseload management; de-escalation & customer service orientation; HIPAA/PHI compliance —

Full job record

Job ID997e6085e56ef8a719f18510a1c5809a8df90735
Org IDc5519d51-d81e-423f-9222-57f34f751e00
Source IDe0ea2e22-8f53-4793-ba61-fd2c0e7555a2
Board IDe0ea2e22-8f53-4793-ba61-fd2c0e7555a2
Provideradp_workforcenow
Provider Job Key613794
TitleAppeals & Grievances Coordinator
Normalized Title—
Statusactive
Activeyes
Location TextMass State, Southborough, MA, US, Southborough, MA
Department—
Team—
Employment Typefull_time
Workplace Type—
Remote Policy—
CountryUnited States
RegionMA
CityMass State
Salary Raw55000.00 To 75000.00 (USD) Annually
Salary Min55,000
Salary Max75,000
Salary CurrencyUSD
Salary Periodyear
Source URLhttps://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=8b6d34a2-662b-4ceb-abfc-528d20745f96&ccId=19000101_000001&lang=en_US&type=JS&jobId=613794&jwId=9201852900666_1
Apply URLhttps://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=8b6d34a2-662b-4ceb-abfc-528d20745f96&ccId=19000101_000001&lang=en_US&type=JS&jobId=613794&jwId=9201852900666_1
First Seen At2026-06-04 09:23:28Z
Last Seen At2026-06-06 12:56:51Z
Last Checked At2026-06-06 12:56:51Z
Last Changed At2026-06-06 12:56:51Z
Inactive At—
Source Posted At2026-06-03 14:22:00Z
Source Updated At—
Raw Payload Uris3://job-postings-prod-raw-590183727216/raw/provider=adp_workforcenow/board=8b6d34a2-662b-4ceb-abfc-528d20745f96|19000101_000001/date=2026-06-06/2026-06-06T12-56-51-672Z-7604aede98ee9538a2b9f1403889009545824d4d5e1ed162e6f5136052e584d5.json
Event Fields
{
  "content_hash": "d7250e4fac6f294cb3b3c63fc95e89ed1599f8b055e6c6e548c44fb45f3ae4b2",
  "source_hash": "9acb64c51a61cfda989210fac3aac25ff344dec706f7b94511099cc25998396d",
  "last_changed_at": "2026-06-06T12:56:51.973Z",
  "active_status": "active"
}
Parsed Structured
{
  "language": "en",
  "location": {
    "raw": "Mass State, Southborough, MA, US, Southborough, MA",
    "city": "Mass State",
    "region": "MA",
    "country": "United States",
    "is_remote": false,
    "confidence": 0.95
  },
  "salary_max": 75000,
  "salary_min": 55000,
  "inferred_at": "2026-06-06T12:56:51.959Z",
  "launch_scope": {
    "reason": "english_us_canada",
    "included": true,
    "language": "en",
    "location": {
      "raw": "Mass State, Southborough, MA, US, Southborough, MA",
      "city": "Mass State",
      "region": "MA",
      "country": "United States",
      "is_remote": false,
      "confidence": 0.95
    },
    "countries": [
      "United States"
    ]
  },
  "remote_policy": null,
  "salary_period": "year",
  "workplace_type": null,
  "salary_currency": "USD"
}
Extensions
{}
Native Structured
{
  "detail": {
    "links": [],
    "itemID": "9201852900666_1",
    "postDate": "2026-06-03T10:22:00.000-04:00",
    "payGradeRange": {
      "maximumRate": {
        "amountValue": 75000,
        "currencyCode": "USD"
      },
      "minimumRate": {
        "amountValue": 55000,
        "currencyCode": "USD"
      }
    },
    "workLevelCode": {
      "shortName": "Full Time"
    },
    "customFieldGroup": {
      "codeFields": [
        {
          "nameCode": {
            "codeValue": "SalaryType"
          },
          "codeValue": "AN",
          "shortName": "Annually"
        },
        {
          "nameCode": {
            "codeValue": "SalaryRangeType"
          },
          "codeValue": "RANGE",
          "shortName": "RANGE"
        }
      ],
      "dateFields": [
        {
          "nameCode": {
            "codeValue": "PostingDate"
          },
          "dateValue": "2026-06-03T10:22Z"
        },
        {
          "nameCode": {
            "codeValue": "CurrentServerDateTime"
          },
          "dateValue": "2026-06-06T08:56Z"
        }
      ],
      "numberFields": [
        {
          "numberValue": 0,
          "categoryCode": {
            "codeValue": "ApplicantCount"
          }
        },
        {
          "categoryCode": {
            "codeValue": "AwardAmount"
          }
        }
      ],
      "stringFields": [
        {
          "nameCode": {
            "codeValue": "ExternalJobID"
          },
          "stringValue": "613794"
        },
        {
          "nameCode": {
            "codeValue": "CareerCenterRefId"
          }
        },
        {
          "nameCode": {
            "codeValue": "GuidelineOid"
          }
        },
        {
          "nameCode": {
            "codeValue": "CurrencySymbolOrCode"
          }
        },
        {
          "nameCode": {
            "codeValue": "HomeDepartment"
          },
          "stringValue": ""
        },
        {
          "nameCode": {
            "codeValue": "JobClass"
          }
        },
        {
          "nameCode": {
            "codeValue": "SalaryRange"
          },
          "stringValue": "55000.00 To 75000.00 (USD) Annually"
        }
      ],
      "indicatorFields": [
        {
          "nameCode": {
            "codeValue": "PriortyStatusFlag"
          },
          "indicatorValue": false
        },
        {
          "nameCode": {
            "codeValue": "InternalPostingFlag"
          },
          "indicatorValue": false
        },
        {
          "nameCode": {
            "codeValue": "MinValue"
          },
          "indicatorValue": true
        },
        {
          "nameCode": {
            "codeValue": "IsVsidApplicable"
          },
          "indicatorValue": true
        },
        {
          "nameCode": {
            "codeValue": "IsSassDlReqForExtPostFlag"
          },
          "indicatorValue": false
        },
        {
          "nameCode": {
            "codeValue": "IsSassDlReqForIntPostFlag"
          },
          "indicatorValue": false
        },
        {
          "nameCode": {
            "codeValue": "IsMonetaryFlag"
          },
          "indicatorValue": false
        },
        {
          "nameCode": {
            "codeValue": "IsNonMonetaryFlag"
          },
          "indicatorValue": false
        }
      ]
    },
    "requisitionTitle": "Appeals & Grievances Coordinator",
    "clientRequisitionID": "1158",
    "organizationalUnits": [],
    "postingInstructions": [],
    "additionalProperties": {},
    "requisitionLocations": [
      {
        "address": {
          "cityName": "Southborough",
          "postalCode": "01772",
          "countrySubdivisionLevel1": {
            "codeValue": "MA"
          }
        },
        "nameCode": {
          "shortName": "Mass State, Southborough, MA, US"
        },
        "aliasNames": []
      }
    ],
    "screeningRequirements": [],
    "requisitionDescription": "<div><div><div><div><div><link href=\"https://static.workforcenow.adp.com/mas/mdf-components/22.46.11/styles/froala_editor.pkgd.min.css\" rel=\"stylesheet\" type=\"text/css\"></div><h1 style=\"margin-left:0in;\" data-pasted=\"true\">Job Summary</h1><p style=\"margin-left:0in;\">nirvanaHealth is rebuilding the payer enterprise on a digital workforce. Our cloud-native Aria platform delivers payer administrative and care-continuum functions as Transaction-as-a-Service (TaaS) &mdash; combining robotic process automation, machine learning, and agentic AI to execute the thousands of transactional functions that currently consume payer operating margin. We operate across Medicare Advantage, Medicaid, Commercial, ASO, and ACA lines of business.</p><p style=\"margin-left:0in;\">As an Appeals &amp; Grievances (A&amp;G) Coordinator, you will help support the intake, review, and resolution of member and provider appeals and grievances while ensuring cases are handled accurately, compliantly, and within CMS-mandated timelines. In this role, you will work closely with the VP of Health Services and partner across clinical, compliance, operations, and customer service teams while using Aria&rsquo;s A&amp;G module and emerging AI-assisted workflows to support member rights and deliver audit-ready outcomes. This position also supports delegated operations, requiring adaptability across process variations while maintaining consistent regulatory compliance.</p><h1 style=\"margin-left:0in;\">Job Responsibilities</h1><div style=\"margin-left:0in;\"><ul style=\"list-style-type: disc;margin-left: -0.25in;\"><li style=\"margin-left:0in;\"><strong>Manage cases end-to-end &mdash;&nbsp;</strong>Receive, document, investigate, and resolve member and provider appeals (Part C and Part D) and grievances submitted via phone, fax, email, mail, or portal. Track and enforce CMS timeliness.</li><li style=\"margin-left:0in;\"><strong>Draft member-facing communications &mdash;&nbsp;</strong>Draft acknowledgment and resolution letters that are clear, empathetic, and fully compliant with CMS, state, and accreditation (NCQA/URAC) requirements.</li><li style=\"margin-left:0in;\"><strong>Collaborate cross-functionally &mdash;&nbsp;</strong>Partner with Medical Directors, Compliance, Pharmacy, Utilization Management, Customer Service, and external review bodies to build complete case folders and drive meaningful outcomes.</li><li style=\"margin-left:0in;\"><strong>Support delegated operations &mdash;&nbsp;</strong>Execute A&amp;G processes across delegated environments, maintaining process variations where needed while adhering to standard operating procedures.</li><li style=\"margin-left:0in;\"><strong>Prepare evidence for external review &mdash;&nbsp;</strong>Compile and organize case files for IRE auto-forwards and external audit bodies.</li><li style=\"margin-left:0in;\"><strong>Leverage emerging tools &mdash;&nbsp;</strong>In addition to MS Office and other Windows-based tools, utilize emerging tools to drive quality and productivity.</li><li style=\"margin-left:0in;\"><strong>Surface insights and support reporting &mdash;&nbsp;</strong>Compile data for regulatory reporting, help identify trends, and contribute to quality improvement initiatives.</li></ul></div><h1 style=\"margin-left:0in;\">Qualifications</h1><div align=\"center\" style=\"margin-left:0in;\"><table border=\"1\" cellspacing=\"0\" cellpadding=\"0\"><tbody><tr><td valign=\"top\" style=\"width: 20.8333%;\"><p style=\"margin-left:0in;\"><strong>Category</strong></p></td><td valign=\"top\" style=\"width: 39.4231%;\"><p style=\"margin-left:0in;\"><strong>Required</strong></p></td><td valign=\"top\" style=\"width: 39.7436%;\"><p style=\"margin-left:0in;\"><strong>Preferred</strong></p></td></tr><tr><td valign=\"top\" style=\"width: 20.8333%;\"><p style=\"margin-left:0in;\"><strong>Education</strong></p></td><td valign=\"top\" style=\"width: 39.4231%;\"><p style=\"margin-left:0in;\">&mdash;</p></td><td valign=\"top\" style=\"width: 39.7436%;\"><p style=\"margin-left:0in;\">Bachelor&#39;s degree or equivalent experience&nbsp;</p></td></tr><tr><td valign=\"top\" style=\"width: 20.8333%;\"><p style=\"margin-left:0in;\"><strong>Experience</strong></p></td><td valign=\"top\" style=\"width: 39.4231%;\"><p style=\"margin-left:0in;\">1&ndash;3 years of related experience</p></td><td valign=\"top\" style=\"width: 39.7436%;\"><p style=\"margin-left:0in;\">Hands-on A&amp;G case management, prior auth, or compliance/quality experience; Medicare Advantage, Medicaid, or Commercial plan environment</p></td></tr><tr><td valign=\"top\" style=\"width: 20.8333%;\"><p style=\"margin-left:0in;\"><strong>Regulatory Knowledge</strong></p></td><td valign=\"top\" style=\"width: 39.4231%;\"><p style=\"margin-left:0in;\">Working familiarity with CMS guidance, Medicare Part C &amp; D regulations, member rights under 42 CFR &sect;&sect;422/423</p></td><td valign=\"top\" style=\"width: 39.7436%;\"><p style=\"margin-left:0in;\">NCQA and/or URAC accreditation standards; Massachusetts state requirements (MassHealth, DOI, Office of Patient Protection)</p></td></tr><tr><td valign=\"top\" style=\"width: 20.8333%;\"><p style=\"margin-left:0in;\"><strong>Writing &amp; Communication</strong></p></td><td valign=\"top\" style=\"width: 39.4231%;\"><p style=\"margin-left:0in;\">Strong professional writing skills &mdash; you will draft acknowledgment, resolution, and determination letters daily; effective verbal communication with members, providers, clinical staff, and external agencies</p></td><td valign=\"top\" style=\"width: 39.7436%;\"><p style=\"margin-left:0in;\">&mdash;</p></td></tr><tr><td valign=\"top\" style=\"width: 20.8333%;\"><p style=\"margin-left:0in;\"><strong>Tools &amp; Technology</strong></p></td><td valign=\"top\" style=\"width: 39.4231%;\"><p style=\"margin-left:0in;\">Microsoft Office (Excel, Word, Outlook); comfort with case management and tracking systems</p></td><td valign=\"top\" style=\"width: 39.7436%;\"><p style=\"margin-left:0in;\">Healthcare payer platform experience</p></td></tr><tr><td valign=\"top\" style=\"width: 20.8333%;\"><p style=\"margin-left:0in;\"><strong>Core Competencies</strong></p></td><td valign=\"top\" style=\"width: 39.4231%;\"><p style=\"margin-left:0in;\">Detail orientation under regulatory deadlines; critical thinking in case investigation; high-volume caseload management; de-escalation &amp; customer service orientation; HIPAA/PHI compliance</p></td><td valign=\"top\" style=\"width: 39.7436%;\"><p style=\"margin-left:0in;\">&mdash;</p></td></tr></tbody></table></div><p style=\"margin-left:0in;\"><br></p></div></div></div></div>\n",
    "sponsoredVisaTypeCodes": []
  },
  "list_job": {
    "links": [],
    "itemID": "9201852900666_1",
    "postDate": "2026-06-03T10:22:00.000-04:00",
    "payGradeRange": {
      "maximumRate": {
        "amountValue": 75000,
        "currencyCode": "USD"
      },
      "minimumRate": {
        "amountValue": 55000,
        "currencyCode": "USD"
      }
    },
    "workLevelCode": {
      "shortName": "Full Time"
    },
    "customFieldGroup": {
      "codeFields": [
        {
          "nameCode": {
            "codeValue": "SalaryType"
          },
          "codeValue": "AN",
          "shortName": "Annually"
        },
        {
          "nameCode": {
            "codeValue": "SalaryRangeType"
          },
          "codeValue": "RANGE",
          "shortName": "RANGE"
        }
      ],
      "dateFields": [
        {
          "nameCode": {
            "codeValue": "PostingDate"
          },
          "dateValue": "2026-06-03T10:22Z"
        },
        {
          "nameCode": {
            "codeValue": "CurrentServerDateTime"
          },
          "dateValue": "2026-06-06T08:56Z"
        }
      ],
      "numberFields": [
        {
          "numberValue": 0,
          "categoryCode": {
            "codeValue": "ApplicantCount"
          }
        },
        {
          "categoryCode": {
            "codeValue": "AwardAmount"
          }
        }
      ],
      "stringFields": [
        {
          "nameCode": {
            "codeValue": "ExternalJobID"
          },
          "stringValue": "613794"
        },
        {
          "nameCode": {
            "codeValue": "CareerCenterRefId"
          }
        },
        {
          "nameCode": {
            "codeValue": "GuidelineOid"
          }
        },
        {
          "nameCode": {
            "codeValue": "CurrencySymbolOrCode"
          }
        },
        {
          "nameCode": {
            "codeValue": "HomeDepartment"
          },
          "stringValue": ""
        },
        {
          "nameCode": {
            "codeValue": "JobClass"
          }
        },
        {
          "nameCode": {
            "codeValue": "SalaryRange"
          },
          "stringValue": "55000.00 To 75000.00 (USD) Annually"
        }
      ],
      "indicatorFields": [
        {
          "nameCode": {
            "codeValue": "PriortyStatusFlag"
          },
          "indicatorValue": false
        },
        {
          "nameCode": {
            "codeValue": "InternalPostingFlag"
          },
          "indicatorValue": false
        },
        {
          "nameCode": {
            "codeValue": "MinValue"
          },
          "indicatorValue": true
        },
        {
          "nameCode": {
            "codeValue": "IsVsidApplicable"
          },
          "indicatorValue": true
        },
        {
          "nameCode": {
            "codeValue": "IsSassDlReqForExtPostFlag"
          },
          "indicatorValue": false
        },
        {
          "nameCode": {
            "codeValue": "IsSassDlReqForIntPostFlag"
          },
          "indicatorValue": false
        },
        {
          "nameCode": {
            "codeValue": "IsMonetaryFlag"
          },
          "indicatorValue": false
        },
        {
          "nameCode": {
            "codeValue": "IsNonMonetaryFlag"
          },
          "indicatorValue": false
        }
      ]
    },
    "requisitionTitle": "Appeals & Grievances Coordinator",
    "clientRequisitionID": "1158",
    "organizationalUnits": [],
    "postingInstructions": [],
    "additionalProperties": {},
    "requisitionLocations": [
      {
        "address": {
          "cityName": "Southborough",
          "postalCode": "01772",
          "countrySubdivisionLevel1": {
            "codeValue": "MA"
          }
        },
        "nameCode": {
          "shortName": "Mass State, Southborough, MA, US"
        },
        "aliasNames": []
      }
    ],
    "screeningRequirements": [],
    "sponsoredVisaTypeCodes": []
  },
  "detail_meta": {
    "url": "https://workforcenow.adp.com/mascsr/default/careercenter/public/events/staffing/v1/job-requisitions/613794?cid=8b6d34a2-662b-4ceb-abfc-528d20745f96&ccId=19000101_000001&lang=en_US&locale=en_US",
    "http_status": 200,
    "content_type": "application/json;charset=UTF-8",
    "response_bytes": 11281
  },
  "detail_errors": []
}
Get this page with API

Rendered from the bluedoor Job Postings API. Reproduce it:

GET https://api.bluedoor.sh/job-postings/v1/jobs/997e6085e56ef8a719f18510a1c5809a8df90735?include=descriptionJSON
GET https://api.bluedoor.sh/job-postings/v1/orgs/c5519d51-d81e-423f-9222-57f34f751e00JSON
GET https://api.bluedoor.sh/job-postings/v1/sources/e0ea2e22-8f53-4793-ba61-fd2c0e7555a2JSON
GET https://api.bluedoor.sh/job-postings/v1/jobs/997e6085e56ef8a719f18510a1c5809a8df90735/eventsJSON

Docs · Get an API key