Grievance & Appeals Coordinator I

This is a fully remote position, open to applicants in California.

📋 Description

• Evaluate and address both verbal and written claims and authorization appeals from healthcare providers.

• Actively seek resolution for formal grievances raised by members.

• Collect, assess, and document complaints, grievances, and appeals from both members and providers.

• Draft response letters for member and provider complaints, grievances, and appeals.

• Keep organized files on individual appeals and grievances.

• May facilitate the Grievance and Appeals Committee.

• Assist pay-for-performance initiatives by entering data, tracking progress, organizing, and researching pertinent information.

• Support HEDIS production tasks, which include data entry, making calls to provider offices, and conducting claims research.

• Handle a large volume of documents, including copying, faxing, and scanning incoming correspondence.

• Undertake additional responsibilities as required.

• Adhere to all policies and standards.

⛳️ Requirements

• Must possess authorization to work in the U.S. without requiring employment-based visa sponsorship now or in the future.

• Must live in close proximity to Woodland Hills, California.

• High school diploma or equivalent required.

• Minimum of 2 years of experience in grievance or appeals, claims, managed care, or relevant fields.

• An Associate’s degree is preferred.

🏝️ Benefits

• Health insurance.

• 401K.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Additional incentive programs may be included in the overall compensation package.

• Equal opportunity employer dedicated to fostering diversity.