Job Description

Title of Position: Paralegal - Grievance and Appeals Claims Analyst

Location: Remote (Preferred Michigan location candidates)

Duration: Long Term

Employment: Contract

Rate: $Negotiable

​ Job Description:

Engagement Description

The Grievance and Appeals (G&A) Claims Analyst is responsible for the end-to-end processing of appeals, grievances, and medical claim disputes received from members, providers, and regulatory agencies. This is a high-level analytical role that requires "thinking on your feet" to resolve a backlog of medical claim cases.

The Analyst will conduct deep-dive research into internal/external resources, review contracts, and apply complex rules to determine if a claim is acceptable. You will facilitate managerial-level conferences, negotiate resolutions, and document every step of the process. Final decisions must be communicated via formal written correspondence that meets strict corporate and regulatory accuracy guidelines.

Top Required Skills & Experience

• High-Level Analytical & Logical Mindset: Ability to examine facts and contextual information to make confident, assertive, and persuasive decisions. Must be a strong negotiator capable of professional "back-and-forth" to reach a resolution.
• Advanced Claims Expertise: Proven experience reading, analyzing, and reviewing claims at a high level. FACETS or NASCO experience is a significant advantage.
• Superior Communication: Outstanding verbal skills for conferences and expert-level writing skills for formal documentation (mastery of grammar, spelling, and punctuation is non-negotiable).

Additional Required Skills

• Research & Logic: Ability to interpret contracts, apply policies/procedures, and structure thorough, logic-based responses.
• Fast-Paced Delivery: Comfortable managing tight deadlines and high-quality standards in a remote environment.
• Technical Proficiency: Strong PC skills, including the MS Office Suite and the ability to navigate multiple complex databases simultaneously.
• Confidentiality: High regard for protecting member, employee, and corporate information.
• Professional Background: Previous experience in a concierge or high-end customer service setting (beyond standard CSR roles).

Preferred Qualifications

• Legal Background: Experience working in a legal setting, paralegal experience, or contract review is a major plus.
• Subject Matter Expertise: Background in research and formal writing.

Education Requirements

Bachelor’s Degree Required. * Preferred Majors: English/Writing, Health Care Administration, History, Juris Doctorate (JD), Paralegal Studies, or Political Science.

About Arthur Grand

Arthur Grand is an IT services firm specializing in Digital Transformation initiatives for Federal, Commercial, State & local customers. Since 2012, Arthur Grand has been successfully supporting and delivering IT services to our customers in the areas of enterprise modernization and transformation with a core focus on emerging technologies including Cloud Solutions (AWS, Azure), Agile Development, Custom Programming, Full Stack Development, DevOps, DevSecOps, CI/CD, Web Development, Mobile APP Development, Data Visualization, Data Warehousing, Financial/ERP System Implementation and Infrastructure Management. Arthur Grand’s culture of delivery excellence, combined with a commitment to bring the best talent to provide services, has earned our company an unparalleled reputation for delivering transformative results.

We are a minority-owned staff augmentation and technology consulting company

To keep our valued employees, we need to keep them engaged in challenging, interesting work, offer market-relevant benefits, and provide continued opportunities for professional growth. Please send your resume for immediate consideration

If you are interested in the above opportunity, we warmly invite you to join our team.

Arthur Grand Technologies is an Equal Opportunity Employer (including disability/vets)

Additional Information

All your information will be kept confidential according to EEO guidelines.