Member Appeals and Grievances Coordinator

Sentara Health

Member Appeals and Grievances Coordinator for Medicaid responsible for investigating appeals and grievances. Position is remote and part of Sentara Health Plans, a leading healthcare organization.

Posted 7/14/2026full-timeRemote • Virginia • 🇺🇸 United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing member appeals and grievances in compliance with state laws and regulations, with a strong focus on collaboration with medical directors and appeals management. Proficient in utilizing JIVA and understanding Medicaid processes to effectively address member concerns.

Highest-signal resume keywords

Managed Care ExperienceMember Appeals ManagementGrievance DocumentationJIVA ProficiencyMedicaid Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Member Appeals ManagementGrievance DocumentationManaged Care Experience

Tools & Technologies

JIVA

Certifications & Qualifications

High School Graduate or Equivalent

Industry Keywords

MedicaidState Law ComplianceProvider AgreementsGroup Agreements

About the role

Key responsibilities & impact

Responsible for the investigation and documentation of member appeals and grievances in compliance with State law, applicable rules and regulations and provider and group agreements.
Works closely with the Plan's Medical Directors who are responsible for all decision regarding clinical appeals/ grievances and the Appeals Manager who is responsible for non-clinical appeals and grievances.

Requirements

What you’ll need

HS - High School Grad or Equivalent REQUIRED
Managed Care- 3 years REQUIRED
Previous member appeals and grievances experience preferred
Experience in JIVA and Medicaid preferred

Benefits

Comp & perks

Medical, Dental, Vision plans
Adoption, Fertility and Surrogacy Reimbursement up to $10,000
Paid Time Off and Sick Leave
Paid Parental & Family Caregiver Leave
Emergency Backup Care
Long-Term, Short-Term Disability, and Critical Illness plans
Life Insurance
401k/403B with Employer Match
Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
Student Debt Pay Down – $10,000
Reimbursement for certifications and free access to complete CEUs and professional development
Pet Insurance
Legal Resources Plan
Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.