How does swipeandhired work?

You set your target roles, salary floor and locations once. swipeandhired scores matching postings against your profile, drafts tailored application materials with AI, and either lets you swipe to apply, one tap at a time, or runs fully on autopilot. Every application is tracked in your dashboard.

Which ATS platforms does swipeandhired support?

All of them. swipeandhired applies on every applicant tracking system (ATS) employers use, including Workday, SmartRecruiters, Greenhouse, iCIMS, Lever, Ashby, Taleo, SuccessFactors, Oracle Cloud and Jobvite, and on a company's own careers page when it uses none of them. You can also bring any posting yourself by link or pasted text.

Can I cancel my subscription?

Anytime, in one click from the billing portal in Settings. Your plan stays active until the end of the current billing period. No retention calls, no dark patterns.

Is my data used for training AI models?

No. Your resume and application data are processed only to run the service for you, matching, drafting, and submitting applications. We never sell your data. If you bring your own AI provider key, requests go directly to your provider under their terms.

Appeals & Grievances Coordinator at Florida Blue, United States, Hybrid, FL

Appeals & Grievances Coordinator at Florida Blue in United States, Hybrid, FL. $20 to $25 an hour. Apply with swipeandhired.

We seek contributors who deliver results with accountability while collaborating seamlessly across boundaries. They embrace change with resilience, staying curious and learning continuously in a rapidly evolving landscape. Grounded in business understanding and comfortable with AI and digital tools, they solve problems with critical thinking and creativity. Above all, they are driven to serve—ensuring their work creates meaningful impact for members and the community we support.

The primary responsibilities of a Medicare Appeals and Grievances Coordinator are centered on daily resolution of Medicare member, member's representatives (which can be a treating physician) and non-participating provider's appeals and grievances in compliance with applicable CMS timeframes and regulations. The Medicare Appeals & Grievances Coordinator is accountable for inventory prioritization of case load to meet various CMS and OIR required SLAs, gathering applicable information related to the case, working with appellants and delegated vendors to obtain for medical records, tracking effectuations, and meeting strict written and oral notification requirements.

What You Will Be Doing

Review appeal and grievance cases from various appellant types (member, member representative, treating physician and non-participating providers) in accordance with CMS regulatory guidelines and timeframes.
Must ensure cases are classified correctly and reviewed for potential expedited requests.
Resolves complex standard or expedited grievances, appeals or disputes involving expressions of dissatisfaction, reimbursement, medical necessity,
Utilization Management and benefits from the various appellant types (member, member representative, treating physician and non-participating providers) in accordance with CMS regulatory guidelines and timeframes.
Prioritize case workload to ensure CMS timeframes and required written notifications are met for various case types:
Standard Pre-Service Appeals
Expedited Pre- Service Appeals
Post Service appeals
Payment Disputes
MA Grievances
Med Supp Grievances

Access various systems such as: MAAGC, JIVA, Diamond, ProviderConnect, Client Letter, ERCMS RADMD, Magellan, and Blue 2 in order to gather pertinent data related to the case and document resolution.
Conduct a thorough research and accurately document pertinent details to include research details, action taken for resolution or outreach to various business partners and attach supporting documents to the case
Coordinates with internal business partners and provides case details, gathers required data or medical records for cases related to clinical decisions, delegated vendors, claims, network, etc.
Ensure proper research is completed with documentation of supporting details to render a final determination with verbal and/or written notification to the appellant within the CMS timeframes
Perform outreach to members, providers, internal and external business partners in order to complete resolution of appeal or grievance
Facilitates escalated calls and issues from providers and/or members regarding appeals or dispute decisions. Escalates any issues or phone calls to the Manager as needed.

What We Require

3+ years related work experience in experience in Member Contact, Enrollment, Maintenance and Billing (EM&B), Claims or Medicare experience.

High school diploma or GED

Additional Required Qualifications

Experience using Siebel, Diamond, JIVA and other Medicare databases.

Ability to work flexible schedule with overtime and weekends when needed

Medicare product knowledge

Ability to work independently and collaboratively as a team member

Excellent interpersonal skills and an ability to recognize, understand, and respond to sensitive member issues or concerns

Ability to manage multiple priorities, have analytical and problem solving skills with attention to detail

What We Prefer

Bachelor’s degree

Strong working knowledge of Medicare Advantage/ Supplement/ Frozen Products, CMS, OIR, DFS and other regulatory requirements

Proven organizational skills with strong attention to detail

Proven ability to work independently, collaboratively and use appropriate judgment to make independent decisions by following guidelines Intermediate PC skills (MS Word, Excel, PowerPoint) Hands-on experience processing Medicare Claims, Written Inquiries or EMB transactions

Current Experience with JIVA, Diamond, ProviderConnect, CustomerConnectClient Letter, ERCMS RADMD, Magellan, and Blue 2

General Physical Demands

Exerting up to 10 pounds of force occasionally to move objects.

Jobs are sedentary if traversing activities are required only occasionally.

Team schedules are determined based on role requirements and business needs. Travel to and from our corporate offices may be required.

What We Offer

As a Florida Blue employee, you will be at the heart of GuideWell’s vision – to lead the nation in transforming health through compassionate, connected, and technology-enabled care that delivers personalized value and empowered living.

To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:

Medical, dental, vision, life and global travel health insurance
Income protection benefits: life insurance, short- and long-term disability programs
Leave programs to support personal circumstances
Retirement Savings Plan including employer match
Paid time off, volunteer time off, 10 holidays and 2 well-being days
Additional voluntary benefits available; and a comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.

To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.
Typical Hourly Offer/Pay Range: $20 - $25

Hourly Pay Range: $20 - $33

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.

We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.