Grievance & Appeals Coordinator I

Location: Remote (California) — Candidates should live within reasonable distance of the Woodland Hills or Natomas offices
Schedule: Monday–Friday, 8:00 AM–5:00 PM (overtime as needed; occasional weekends/holidays)
Duration: 12-month assignment with potential to extend or convert
Pay Rate: $23/hour

Position Summary

The Grievance & Appeals Coordinator supports the resolution of member and provider grievances and appeals by analyzing claims, authorizations, and formal complaints. This role ensures timely, accurate case handling while maintaining high quality and compliance standards.

Key Responsibilities

Review, analyze, and resolve verbal and written grievances and appeals from members and providers
Prepare clear, professional written response letters
Maintain accurate files and documentation for all cases
Track and manage large volumes of case-related documents
Support committee coordination related to grievance and appeals processes
Assist with quality initiatives, including performance tracking and reporting
Support HEDIS-related activities such as data entry, provider outreach, and claims research
Collaborate closely with team members to meet quality, accuracy, and turnaround benchmarks

Qualifications

Required:

High school diploma or equivalent
2–3 years of experience in grievances and appeals, claims, healthcare administration, or a regulated healthcare environment
Strong written, verbal, and problem-solving skills
High attention to detail and ability to manage multiple cases simultaneously

Preferred:

Associate’s degree
Knowledge of healthcare regulations (e.g., Medicare/Medicaid)
Experience handling complex or compliance-related cases
Strong letter-writing and documentation skills
Conflict resolution or cross-functional coordination experience

Performance Expectations

Meet or exceed 97% quality and accuracy standards
Resolve cases efficiently while maintaining compliance and customer satisfaction
Communicate effectively and collaborate across teams

Ideal Candidate Traits

Detail-oriented and organized
Professional, empathetic communicator
Analytical and solution-focused
Comfortable working independently in a remote environment while staying engaged with the team

CLIENT does not discriminate in employment on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other non-merit factor.

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