Grievance & Appeals Coordinator I

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

📋 Description

• Evaluate and resolve verbal and written claims as well as authorization appeals submitted by providers.

• Actively seek resolution for formal grievances raised by members.

• Collect, analyze, and document verbal and written complaints, grievances, and appeals from both members and providers.

• Draft response letters addressing complaints, grievances, and appeals from members and providers.

• Keep organized files for individual appeals and grievances.

• Coordinate the Grievance and Appeals Committee as necessary.

• Assist pay-for-performance programs through data entry, tracking, organizing, and researching relevant information.

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

• Handle documents, including copying, faxing, and scanning incoming correspondence.

• Execute other assigned duties as required.

⛳️ Requirements

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

• Candidates should reside in proximity to Woodland Hills, California.

• High school diploma or equivalent is required.

• A minimum of 2 years of experience in grievance or appeals, claims, related managed care experience, or a similar field.

• Capability to gather, analyze, and report on member and provider complaints, grievances, and appeals.

• An Associate’s degree is preferred.

• Proficient in managing a large volume of documents.

• Must adhere to all policies and standards.

🏝️ Benefits

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off.

• Holidays.

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

• Additional forms of incentives may be included in the overall compensation package.

• An equal opportunity employer dedicated to promoting diversity.