NEMT Grievances & Appeals Specialist
Medidrive LLC · Posted Nov 10, 2026
- United States
- 2+ years
Responsible for managing, investigating, and resolving member complaints, grievances, and appeals in compliance with client, state, and federal requirements.
Responsibilities
- Receive, log, and acknowledge grievances and appeals from members, providers, clients, and regulatory agencies
- Conduct thorough investigations by collecting trip records, call recordings, provider documentation, GPS data, and relevant system notes
- Analyze root causes of service failures and recommend corrective and preventative actions
- Draft clear, compliant written responses to members and clients within required turnaround timeframes
- Escalate urgent or high-risk matters to the Quality Assurance Manager and leadership as appropriate
Requirements
- High school diploma required; Associate or Bachelor’s degree preferred
- Nice to have: experience in Medicaid or Medicare Advantage environments
- Nice to have: medical front-office, case management, social work, or healthcare administrative experience
- Nice to have: bilingual (English/Spanish or other languages)