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Pyramid Consulting, Inc · 2 days ago

Case Manager – Appeals & Grievances

United States

Full-time

Remote

Entry, Mid Level

$20/hr - $25/hr

2+ years exp

Pyramid Consulting, Inc. is seeking a detail-oriented Case Manager – Appeals & Grievances to investigate, coordinate, and resolve member complaints, grievances, and appeals in compliance with health plan and regulatory standards. This role ensures timely and fair resolutions, accurate documentation, and strong cross-functional collaboration.

ConsultingInformation TechnologyLegalProfessional ServicesSoftwareStaffing Agency

Growth Opportunities

H1B Sponsor Likely

Responsibilities

We are seeking a detail-oriented Case Manager – Appeals & Grievances to investigate, coordinate, and resolve member complaints, grievances, and appeals in compliance with health plan and regulatory standards

This role ensures timely and fair resolutions, accurate documentation, and strong cross-functional collaboration

Qualification

Appeals ManagementGrievances ManagementUtilization ManagementCMS StandardsDMHC StandardsNCQA StandardsCare Coordination

Required

2 years experience in Appeals, Grievances, Utilization Management, or Care Coordination in a health plan or TPA

Strong understanding of CMS, DMHC, and NCQA regulatory standards

Benefits

Health insurance (medical, dental, vision)

401(k) plan

Paid sick leave (depending on work location)

Company

Pyramid Consulting, Inc

Glassdoor4.2

Pyramid Consulting, a global leader in workforce and technology solutions, empowers individuals and organizations to transform and thrive in the most challenging and competitive markets.

Founded in 1996

Alpharetta, Georgia, USA

5001-10000 employees

https://pyramidci.com/

H1B Sponsorship

Pyramid Consulting, Inc has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (178)

2024 (112)

2023 (95)

2022 (62)

2021 (50)

2020 (117)