Appeals and Grievances Specialist

Sidecar Health is redefining health insurance. Our mission is to make excellent healthcare affordable and accessible for everyone. We know that to accomplish this lofty mission, we need driven people who will make things happen.

The passionate people who make up Sidecar Health’s team come from all over, with backgrounds as tech leaders, policy makers, healthcare professionals, and beyond. And they all have one thing in common—the desire to fix a broken system and make it more personalized, affordable, and transparent.

If you want to use your talents to transform healthcare in the United States, come join us!

As an Appeals and Grievances Specialist, you'll own the end-to-end handling of member and provider appeals and grievances, investigating cases, coordinating with internal teams, and delivering clear, well-reasoned resolutions within regulatory timelines.

This role sits at the intersection of advocacy, compliance, and operations. You'll work directly with members and providers who need someone to take their concern seriously, dig into the details, and get them an answer they can trust. You'll report to the Director, Quality and Continuous Improvement, and work closely with QA, Claims, Clinical, and Provider Relations to reach fair, well-documented outcomes.

• Intake, triage, and manage a caseload of member and provider appeals and grievances from submission through resolution

• Investigate each case thoroughly, reviewing claims history, benefit determinations, clinical documentation, and prior correspondence

• Apply plan documents, state and federal regulations, and Sidecar Health policy to reach accurate, well-documented determinations

• Draft clear, compliant resolution letters and member and provider communications in Sidecar Health's brand voice

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