Grievance & Appeals Specialist
Company: NationsBenefits
Location: Fort Lauderdale
Posted on: January 5, 2026
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Job Description:
Job Description Company Overview: NationsBenefits is recognized
as one of the fastest-growing companies in America and a Healthcare
Fintech provider of supplemental benefits, flex cards, and member
engagement solutions. We partner with managed care organizations to
provide innovative healthcare solutions that drive growth, improve
outcomes, reduce costs, and bring value to their members. Through
our comprehensive suite of innovative supplemental benefits,
fintech payment platforms, and member engagement solutions, we help
health plans deliver high-quality benefits to their members that
address the social determinants of health and improve member health
outcomes and satisfaction. Our compliance-focused infrastructure,
proprietary technology systems, and premier service delivery model
allow our health plan partners to deliver high-quality, value-based
care to millions of members. We offer a fulfilling work environment
that attracts top talent and encourages all associates to
contribute to delivering premier service to internal and external
customers alike. Our goal is to transform the healthcare industry
for the better! We provide career advancement opportunities from
within the organization across multiple locations in the US, South
America, and India. Position Summary As a member of The Grievance
and Appeals Department, Specialists are responsible for
investigating and processing grievances and appeals received by
members or directly from contracted health plans. This is a
challenging role with serious impact.You will need strong
analytical skills and the ability to effectively interact with
other departments. Specialists work collaboratively with other
internal and external functional areas and stakeholders as
necessary to resolve grievances and appeals in the allocated
timeframes. You will also need to effectively draft correspondence
that explains the grievance and appeals resolution/outcome as well
as next steps/actions for the member and/or provider. Role and
Responsibilities Responds to member (customer) and client (health
plan) inquiries (via phone, written, e-mail, or fax) regarding all
aspects of our business in a professional, timely, accurate, and
caring manner while consistently meeting all guidelines. Reviews,
research, and directs complaints, grievances to appropriate
personnel, and follows up to ensure that resolution has occurred,
documentation is complete, required time frames are met, and proper
written communication of the decision has occurred. In most cases,
prepares the written communication of the decision in plain written
language for client. Coordinates additional follow up activities
with appropriate department managers and/or leads and tracks to
conclusion. Maintains grievance and appeal case files. Responds to
member, provider, client and other inquiries via telephone or
written correspondence while meeting all corporate guidelines and
client performance standards. Responsible for coordination of all
components of complaints/appeals including final communication to
Client for final resolution and closure. Follow up to assure
complaint/appeal is handled within established timeframe to meet
company and regulatory requirements. Demonstrates appropriate
customer-care skills such as empathy, active listening, courtesy,
politeness, helpfulness, and other skills as identified. Records,
investigates, and resolves member complaints. Assists in the
education of new members/providers and in the re-education of
existing members/providers regarding health plan procedures. Track
grievance case by client and line(s) of business for compliance and
review. Assist in resolving member and provider complaints. Behaves
in accordance with company core values and expectations
(initiative, accountability) Performs skills necessary to create a
high-quality customer experience, as reflected through acceptable
quality audit score and productivity. Triage incomplete components
of complaints to appropriate subject matter expert within company
for resolution response content to be included in final resolution
response. Additional activities may include: Responsible for
compliance with all federal, state, and local laws, rules and
regulations affecting Company. Qualifications and Education
Requirements College degree preferred 1-3 years of industry related
experience in healthcare compliance, operations, customer service,
quality, or applicable experience in healthcare 1-year grievance
and appeals experience preferred. Preferred Skills Strong written
and verbal communication skills and an ability to work with people
from diverse backgrounds. Grievance & Appeals, Customer Service,
Training Quality assurance (3 years) Medicare and Health Insurance
knowledge Ability to multi-task, good organizational, and time
management skills. Ability to act on feedback provided by showing
ownership of their own development. Ability to read, analyzes, and
interprets verbal and written instructions. Ability to write
business correspondence. Ability to effectively present information
and respond to questions from members. Ability to define problems
collects data, establish facts, and draw valid conclusions. Ability
to work effectively within a team environment. Strong interpersonal
and written and verbal communication skills. Clear, concise, and
persuasive writing and presentation skills. Ability to identity,
analyze and investigate potential issues. NationsBenefits is an
equal opportunity employer.
Keywords: NationsBenefits, Fort Lauderdale , Grievance & Appeals Specialist, Customer Service & Call Center , Fort Lauderdale, Florida
