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Appeals & Grievances Specialist
Job Location:
Job Location:
Philadelphia, PA - USA
Hourly Salary:
USD 29 - 29
Hourly Salary:
Posted:
14 October 2026 (9 days ago)
Posted:
Application Deadline:
11 January 2027
Application Deadline:
Vacancies:
1 Vacancy
Vacancies:
Job Summary
A client of Innova Solutions is immediately hiring for Appeals & Grievances Specialist
Position Type: Contract to Hire
Duration: 03 Months
Location: Philadelphia PA
As an Appeals & Grievances Specialist you will:
The Ideal Candidate will have:
Qualified candidates should APPLY NOW for immediate consideration!
This position is only open to applicants who can be engaged on a W-2 basis. 1099 contractors and Corp-to-Corp arrangements will not be considered for this position.
Please hit APPLY to provide the required information and we will be back in touch as soon as possible.
We are currently interviewing to fill this and other similar positions. If this role is not a fit for you we do offer a referral bonus program for referrals that we successfully place with our clients subject to program guidelines.
REFERRAL PROGRAM:
This position qualifies for a Referral Bonus amount of $250-$1000 dollars. Click here to learn more Referral Program. Please email your referral details along with their resume to
Pranshi Srivastava
(1)
PAY RANGE AND BENEFITS:
Pay Range*: $25 - $29 per hour
Pay range offered to a successful candidate will be based on several factors including the candidates education work experience work location specific job duties certifications etc.
Benefits: Innova Solutions offers benefits( based on eligibility) that include the following: Medical & pharmacy coverage Dental/vision insurance 401(k) Health saving account (HSA) and Flexible spending account (FSA) Life Insurance Pet Insurance Short term and Long term Disability Accident & Critical illness coverage Pre-paid legal & ID theft protection Sick time and other types of paid leaves (as required by law) Employee Assistance Program (EAP).
ABOUT INNOVA SOLUTIONS: Founded in 1998 and headquartered in Atlanta Georgia Innova Solutions employs approximately 50000 professionals worldwide and reports an annual revenue approaching $3 Billion. Through our global delivery centers across North America Asia and Europe we deliver strategic technology and business transformation solutions to our clients enabling them to operate as leaders within their fields.
Recent Recognitions:
Website: Solutions is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment. Innova Solutions is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment on the basis of race color religion or belief national origin citizenship social or ethnic origin sex age physical or mental disability veteran status marital status domestic partner status sexual orientation or any other status protected by the statutes rules and regulations in the locations where it operates. If you are an individual with a disability and need a reasonable accommodation to assist with your job search or application for employment please contact us at or . Please indicate the specifics of the assistance needed. Innova Solutions encourages all interested and qualified candidates to apply for employment opportunities. Innova Solutions (HireGenics/Volt) does not discriminate against applicants based on citizenship status immigration status or national origin in accordance with 8 U.S.C. 1324b.
The company will consider for employment qualified applicants with arrest and conviction records in a manner that complies with the San Francisco Fair Chance Ordinance the Los Angeles Fair Chance Initiative for Hiring Ordinance and other applicable laws.
By applying for this job I agree to receive calls and emails (including automated or AI-generated calls or emails) from Innova Solutions its identified recruiting partners regarding this job and future recruiting and job-placement opportunities. I understand that my consent is not a condition of employment or services and that I may revoke my consent at any time by following the Opt Out Instructions.
I confirm that I have read and agree to the Terms of Serviceand acknowledge that I have received and reviewed the Privacy Notice.
Position Type: Contract to Hire
Duration: 03 Months
Location: Philadelphia PA
As an Appeals & Grievances Specialist you will:
- Manage assigned appeals from case receipt through investigation determination notification effectuation and closure while meeting all regulatory and internal turnaround times.
- Accurately identify the substance of the appeal and reconcile discrepancies among the appeal request denial letter claim authorization and case-system information. Escalate unclear or incorrectly routed cases before compliance is affected
- Investigate the appellant argument by interpreting applicable member benefits Evidence of Coverage benefit booklets
- Summary Plan Descriptions claims history Explanation of Benefits authorization records denial rationale medical and claim-payment policies CMS guidance state requirements operational reference materials.
- Prepare complete external-review packages submit them through the designated process within required timeframes monitor for determinations and document the outcome and follow-up actions.
- Draft and validate acknowledgment request-for-information dismissal and determination correspondence using the correct approved template addressee appeal rights timeframe rationale benefit or policy reference and required regulatory language.
- Initiate overturned-case effectuation or claim-adjustment requests monitor completion reconcile outstanding tasks and ticklers and escalate delays that present member financial quality or compliance risk.
- Use appeal and supporting systems effectively including the case-management system claims and eligibility platforms authorization systems document repositories communication tools policy libraries and applicable vendors or external-review portals.
The Ideal Candidate will have:
- Bachelors degree in healthcare administration business population health or related field.
- Minimum of 3 years working in healthcare operations.
- knowledge of plan products benefits and claims procedures.
- Experience in Utilization Management or Appeals and Grievances.
Qualified candidates should APPLY NOW for immediate consideration!
This position is only open to applicants who can be engaged on a W-2 basis. 1099 contractors and Corp-to-Corp arrangements will not be considered for this position.
Please hit APPLY to provide the required information and we will be back in touch as soon as possible.
We are currently interviewing to fill this and other similar positions. If this role is not a fit for you we do offer a referral bonus program for referrals that we successfully place with our clients subject to program guidelines.
REFERRAL PROGRAM:
This position qualifies for a Referral Bonus amount of $250-$1000 dollars. Click here to learn more Referral Program. Please email your referral details along with their resume to
Pranshi Srivastava
(1)
PAY RANGE AND BENEFITS:
Pay Range*: $25 - $29 per hour
Pay range offered to a successful candidate will be based on several factors including the candidates education work experience work location specific job duties certifications etc.
Benefits: Innova Solutions offers benefits( based on eligibility) that include the following: Medical & pharmacy coverage Dental/vision insurance 401(k) Health saving account (HSA) and Flexible spending account (FSA) Life Insurance Pet Insurance Short term and Long term Disability Accident & Critical illness coverage Pre-paid legal & ID theft protection Sick time and other types of paid leaves (as required by law) Employee Assistance Program (EAP).
ABOUT INNOVA SOLUTIONS: Founded in 1998 and headquartered in Atlanta Georgia Innova Solutions employs approximately 50000 professionals worldwide and reports an annual revenue approaching $3 Billion. Through our global delivery centers across North America Asia and Europe we deliver strategic technology and business transformation solutions to our clients enabling them to operate as leaders within their fields.
Recent Recognitions:
- Named One of Americas Best Employers for New Grads by Forbes (2024)
- Named One of the Best Companies to Work for by U.S. News & World Report (Private Companies List 2024-2025)
- One of the Largest IT Staffing Firms in the US Ranked #3 by Staffing Industry Analysts (SIA 2024)
- One of the Largest Staffing Firms in the US Ranked #13 by Staffing Industry Analysts (SIA 2024; includes Innova Solutions Volt & HireGenics)
- Named One of the Top Ten Private Companies in Atlanta by the Atlanta Business Chronicle (2023)
- One of the Largest Certified Minority Business Enterprises (MBEs) in the United States (NMSDC 2024)
- AWS Advanced Tier Services Partner with 100 certifications
Website: Solutions is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment. Innova Solutions is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment on the basis of race color religion or belief national origin citizenship social or ethnic origin sex age physical or mental disability veteran status marital status domestic partner status sexual orientation or any other status protected by the statutes rules and regulations in the locations where it operates. If you are an individual with a disability and need a reasonable accommodation to assist with your job search or application for employment please contact us at or . Please indicate the specifics of the assistance needed. Innova Solutions encourages all interested and qualified candidates to apply for employment opportunities. Innova Solutions (HireGenics/Volt) does not discriminate against applicants based on citizenship status immigration status or national origin in accordance with 8 U.S.C. 1324b.
The company will consider for employment qualified applicants with arrest and conviction records in a manner that complies with the San Francisco Fair Chance Ordinance the Los Angeles Fair Chance Initiative for Hiring Ordinance and other applicable laws.
By applying for this job I agree to receive calls and emails (including automated or AI-generated calls or emails) from Innova Solutions its identified recruiting partners regarding this job and future recruiting and job-placement opportunities. I understand that my consent is not a condition of employment or services and that I may revoke my consent at any time by following the Opt Out Instructions.
I confirm that I have read and agree to the Terms of Serviceand acknowledge that I have received and reviewed the Privacy Notice.
Required Experience:
IC
