Grievance & Appeals Coordinator I

Immediate need for a talented Grievance & Appeals Coordinator I. This is a 12+ months contract opportunity with long-term potential and is located in Woodland Hills, CA(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID: 25-83333

Pay Range: $19 - $20/hour.  Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Shift: 8 AM - 5 PM PST (Mon-Fri)
• Will handle member appeals and grievances-
• Will be a high-volume case load requiring research to resolved member dissatisfaction.
• Will place some outgoing calls.
• Processing and resolving member appeals and grievances, ensuring each case is handled with accuracy and timeliness.
• The coordinator collaborates closely with the member and team on cases, providing essential support and maintaining clear communication throughout the process.
• The role also involves contributing to continuous improvement initiatives, identifying opportunities to enhance operational efficiency and customer satisfaction.
• Daily tasks require a keen attention to detail, effective problem-solving, and teamwork within a supportive and collaborative environment.
• Gather, analyze, and report verbal and written member and provider complaints, grievances, and appeals.
• Prepare response letters for member and provider complaints, grievances, and appeals.
• Maintain files on individual appeals and grievances
• May coordinate the Grievance and Appeals Committee.
• Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information.
• Assist with HEDIS production functions including data entry, calls to provider’s offices, and claims research.
• Manage large volumes of documents including copying, faxing, and scanning incoming mail.

Key Requirements and Technology Experience:  

• Key skills; Requires good analytical, prioritization and written/communication skills.
• 2-3 years of experience in a similar role, preferably within appeals and grievances, healthcare administration.
• Experience working with complex cases or compliance-related tasks is highly desirable.
• Knowledge of Healthcare Regulations – Understanding of health plan compliance, regulatory requirements, or experience with Medicare/Medicaid guidelines.
• Conflict Resolution Skills – Ability to handle sensitive cases with professionalism and empathy. 
• Project Coordination Experience – Exposure to coordinating cross-functional projects or initiatives in a fast-paced environment. 
• Good Letter writing skills.
• High school diploma or equivalent.
• Associate’s degree preferred.
• 2+ years grievance or appeals, claims, or related managed care experience.
• Strong oral, written, and problem-solving skills.

Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
 
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