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!
About the Role
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.
What You'll Do
- 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
- Track all cases and deadlines to ensure compliance with state and federal turnaround time requirements
- Coordinate with Claims, Clinical, Provider Relations, and Legal teams to gather information and resolve complex cases
- Identify escalation risks and loop in leadership or the Grievance Committee when a case requires second-level review
- Spot patterns in appeals and grievances that point to upstream process, system, or communication issues, and flag them to leadership
- Maintain accurate records in the case management system to support audits and regulatory reporting
- Contribute to process improvements, SOP updates, and knowledge base articles for the appeals and grievance’s function
What You'll Bring
- Bachelor's degree required, in a relevant field such as healthcare administration, business, public health, or a related discipline
- 3+ years of experience in appeals and grievances, claims adjudication, utilization review, or a related health insurance operations role
- Working knowledge of health insurance regulatory requirements for appeals and grievances (state DOI requirements, ERISA, ACA as applicable)
- Strong analytical skills, comfortable reading claims data, plan documents, and clinical notes to form a defensible conclusion
- Excellent written communication skills; able to explain complex determination in plain, empathetic language
- A track record of managing a caseload independently and meeting hard deadlines
- Comfort working across systems and teams to track down the information a case needs
- A member-first mindset, balanced with rigorous attention to policy and compliance
Nice to haves
- Experience with Genesys Cloud, Salesforce, or similar case management and CRM platforms
- Familiarity with Medicare Advantage or ACA marketplace appeals processes
- Prior experience in a fast-growing or start-up health insurance environment
What You'll Get
- Competitive salary ($65,000 - $75,000), bonus opportunity, and equity package
- Comprehensive Medical, Dental, and Vision benefits
- A 401k retirement plan
- Paid vacation and company holidays
- Opportunity to make an impact at a rapidly growing mission-driven company transforming healthcare in the U.S.
Sidecar Health is an Equal Opportunity employer committed to building a diverse team. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status or disability status.
Skills Required
- Bachelor's degree in healthcare administration, business, public health, or related field
- 3+ years experience in appeals and grievances, claims adjudication, utilization review, or related health insurance operations role
- Working knowledge of health insurance regulatory requirements for appeals and grievances (state DOI, ERISA, ACA as applicable)
- Strong analytical skills; comfortable reading claims data, plan documents, and clinical notes to form defensible conclusions
- Excellent written communication skills; able to explain complex determinations in plain, empathetic language
- Track record of managing a caseload independently and meeting hard deadlines
- Comfort working across systems and teams to gather necessary case information
- Member-first mindset balanced with rigorous attention to policy and compliance
- Experience with Genesys Cloud, Salesforce, or similar case management and CRM platforms
- Familiarity with Medicare Advantage or ACA marketplace appeals processes
- Prior experience in a fast-growing or start-up health insurance environment
Sidecar Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Sidecar Health and has not been reviewed or approved by Sidecar Health.
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Fair & Transparent Compensation — Compensation in tech and product roles is described as market‑aligned and competitive. Feedback suggests many in these functions feel total pay stacks up well against peers.
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Healthcare Strength — Employer‑paid major‑medical coverage for employees and family is highlighted, positioning health benefits as a strong component of total rewards. Feedback suggests low denial rates, added navigation tools, and center‑of‑excellence partnerships reinforce the plan’s practical value.
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Equity Value & Accessibility — Total rewards are presented to include stock options and bonuses in addition to salary. Feedback suggests these elements can meaningfully enhance perceived upside beyond base pay.
Sidecar Health Insights
What We Do
Sidecar Health is changing the health industry with modern, common-sense health insurance that finally gives consumers control over costs and choices. We are a passionate group of people-people on a mission to make quality healthcare affordable and accessible for everyone.
Why Work With Us
Being a growth-stage distributed startup, transparent and asynchronous communication is critical. We'll provide you with the resources and tools you need, and regularly seek your feedback through quarterly engagement pulses on what is or isn't working well.
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