CTM Coordinator, Appeals & Grievances

Alignment Health

. Monitor the CTM portal daily for new cases .

Posted 10/6/2026full-timeRemote • United StatesJunior💰 $48,373 - $72,559 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing CTM cases, grievances, and appeals within Medicare Advantage healthcare plans, ensuring compliance with CMS guidelines and regulatory deadlines. Strong communication and problem-solving skills are essential for effective member outreach and documentation.

Highest-signal resume keywords

CTM Case ManagementMedicare Advantage ExperienceStrong Communication SkillsRegulatory ComplianceBilingual in English and Spanish

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Case DocumentationCMS GuidelinesData TrackingReport PreparationBasic ArithmeticTyping Speed of 40 WPM10-Key Keypad ProficiencyGrievance InvestigationPolicy ReviewAudit Preparation

Soft Skills

Problem-SolvingOrganizational SkillsTime ManagementLeadershipCollaboration

Certifications & Qualifications

High School Diploma or GEDAssociate Degree (Preferred)

Industry Keywords

Member ServicesCMS STAR PerformanceHealthcare ComplianceGrievance TrendsComplaint Volume Reduction

About the role

Key responsibilities & impact

Monitor the CTM portal daily for new cases
Acknowledge receipt of CTM grievances and appeals cases
Gather information from members, providers, internal departments, and delegated entities to determine appropriate resolutions
Notify appropriate parties and ensure completion of internal processes before regulatory deadlines
Conduct verbal and written outreach to members and providers in accordance with plan policy and CMS guidelines
Conduct unbiased, accurate, timely, and comprehensive investigations of CTM cases, grievances, and appeals
Document all actions taken to resolve cases in accordance with CMS regulatory timeframes and internal policies
Track cases to closure with timely and comprehensive documentation satisfying CMS requirements
Process CTM cases, grievances, and appeals according to CMS guidelines and plan policy
Draft clear, compliant written responses to CMS within required turnaround times
Prepare objective, accurate, and comprehensive case histories for committee meetings and workgroups
Prepare monthly and quarterly reports
Assist with compliance reporting and regulatory audits
Identify appeal, grievance, and complaint trends, systemic issues, and opportunities to improve member experience and reduce complaint volume
Contribute suggestions supporting strong CMS STAR performance
Participate in reviews and updates of CTM, grievance, and appeal policies and procedures
Participate in CMS audit preparation and regulator meetings and interviews
Meet or exceed internal and regulatory deadlines
Perform other duties as assigned

Requirements

What you’ll need

At least one year of Member Services or similar experience
2+ years of experience working with Medicare Advantage healthcare plans
High school diploma or GED
Strong oral and written communication skills
Ability to draft CMS-facing correspondence
High attention to detail and ability to manage multiple deadline-driven cases simultaneously
Ability to type at least 40 words per minute and use a 10-key keypad by touch
Ability to communicate positively, professionally, and effectively; demonstrate leadership; teach; and collaborate across departments
Ability to establish and maintain constructive relationships with diverse members, management, employees, and vendors
Ability to read and interpret safety rules, operating and maintenance instructions, and procedure manuals; write routine reports and correspondence; and speak effectively before groups of customers or employees
Ability to perform basic arithmetic using units of U.S. currency and measurements of weight, volume, and distance
Ability to apply logic and reasoning to address problems efficiently and strategically
Effective problem-solving, organizational, and time-management skills
Preferred: Direct experience working with CTM cases at a Medicare Advantage healthcare plan
Preferred: Associate degree (A.A.)
Preferred: Bilingual in English and Spanish

Benefits

Comp & perks

Remote work
Opportunity for growth and innovation
Equal Opportunity/Affirmative Action employment