Grievance and Appeals Auditor I

Job overview

The Grievance and Appeals Auditor I role is fully remote. Annual salary is $57,000–$65,000. Solis Health Plans provides health plan services, and this role supports audits of appeals and grievance cases across Medicare Advantage and other managed care lines of business. The auditor reviews case accuracy, clinical and coverage determinations, procedural compliance, and timeliness against regulatory requirements. By documenting findings and identifying trends and risks, the role supports audit readiness and improvements to grievance and appeals processes.

What you'll do

• Conduct pre- and post-resolution audits of member appeals and grievance cases
• assess compliance with CMS requirements, internal policies, and regulatory timeframes
• review eligibility, coverage, medical necessity, clinical rationale, documentation, and communications
• validate review levels and required notices
• identify procedural errors and documentation gaps
• document findings with regulatory citations and impact assessments
• prepare audit reports
• track trends
• recommend corrective actions and process improvements
• collaborate with clinical, compliance, and operational teams.

What we're looking for

Skills & competencies

grievance and appeals auditor

fully remote

health plans

medicare advantage

cms compliance

solis health plans

$57k–$65k/year

audit and compliance

case review

regulatory reporting

quality improvement

full-time

Work arrangement

• Weekend coverage required

Why this role

Fully remote role focused on Medicare Advantage and managed-care appeals and grievance audits, including CMS compliance and regulatory readiness.

About the employer

Solis Health Plans is hiring for this role. Industry: Direct Health and Medical Insurance Carriers. Sector: 52.