Help members navigate some of the most confusing parts of healthcare from the comfort of your home. If you know your way around utilization management and want a Monday through Friday schedule with solid pay, this Appeals and Grievance Specialist role should be on your shortlist.
About BroadPath
BroadPath partners with leading health plans to deliver specialized, work from home support across claims, utilization management, and member services. As an Appeals and Grievance Specialist, you become the trusted guide for members working through Appeals, External Medical Review, and State Fair Hearing processes. BroadPath combines strong training, structured workflows, and a supportive remote culture to help you do your best work.
Schedule
- Fully remote position within the United States
- Training: 2 weeks, Monday through Friday, 8:00 a.m. to 5:00 p.m. CST
- Production: Monday through Friday, 8:00 a.m. to 5:00 p.m. CST
- No weekends
What You’ll Do
- Serve as the first point of contact for members regarding Appeals, External Medical Review, and State Fair Hearings
- Help members understand their rights, responsibilities, and options throughout the appeals journey
- Act as an advocate for members by gathering information, preparing cases, and supporting them through hearings and reviews
- Translate member communications and documents between English and Spanish, preserving intent and clarity
- Coordinate with Claims, Eligibility, Provider Relations, Business Operations, and other health plan teams to resolve concerns
- Monitor real time queues, service levels, and escalations to ensure timely responses
- Initiate and manage EMR and State Fair Hearing processes using the HHSC TIERS portal, tracking compliance and timelines
- Enter accurate data into Utilization Management systems for EMR, Fair Hearing, and related activities
- Support Utilization Management workflows by collecting member and provider information and applying ICD 10, CPT, and HCPCS knowledge
- Participate in quality initiatives, projects, and process improvement efforts based on trends you see in daily work
What You Need
- High school diploma or equivalent
- 4 or more years of foundational Utilization Management experience
- General understanding of health plan operations, claims and eligibility systems, and healthcare benefits
- Familiarity with Texas Department of Insurance and HHSC rules for managing member complaints and appeals
- Experience with managed care, Medicaid programs, call center tools, and customer service practices
- Strong interpersonal skills, professional phone etiquette, and clear verbal communication
- Active listening skills and the ability to handle multiple tasks at once without losing accuracy
- Comfort with medical terminology and UM codes (ICD 10, CPT, HCPCS)
- Strong problem solving abilities and high attention to detail
- Ability to work independently in a remote environment and collaborate with cross functional teams
Preferred
- 2 or more years of direct experience with UM Prior Authorizations, Appeals, Fair Hearings, and External Medical Review
- Community Health Worker (CHW) certification from the Texas Department of State Health Services
- Background in benefits, claims processing, or membership support
Benefits
- Competitive base pay up to 22 dollars per hour
- Weekly pay schedule
- Monday through Friday schedule with no weekends
- Fully remote role with a stable daytime schedule
- Opportunity to deepen your expertise in Appeals, EMR, Fair Hearings, and Utilization Management
- Inclusive, diverse culture that values different backgrounds and perspectives
Roles like this fill quickly, especially with weekday only hours and competitive pay, so get your application in while this seat is still open.
If you are ready to put your UM experience and member first mindset to work in a true work from home role, this is a strong next step in your career.
Happy Hunting,
~Two Chicks…