Grievance & Appeals Coordinator I

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

📋 Description

• Analyze and address both verbal and written claims along with authorization appeals from providers.

• Actively pursue the resolution of formal grievances submitted by members.

• Collect, assess, and report on verbal and written complaints, grievances, and appeals from both members and providers.

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

• Keep organized records on individual appeals and grievances.

• May oversee the Grievance and Appeals Committee.

• Contribute to pay-for-performance initiatives through data entry, tracking, organizing, and researching relevant information.

• Assist with HEDIS production tasks, which include data entry, contacting provider offices, and conducting claims research.

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

• Execute other duties as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• Applicants must reside in California.

• High school diploma or equivalent is required.

• A minimum of 2 years of experience in grievances or appeals, claims, managed care, or related fields is necessary.

• Prior experience in healthcare, customer service, and/or claims is preferred.

• An Associate’s degree is preferred.

• Capability to analyze and resolve verbal and written claims and authorization appeals.

• Proficiency in gathering, analyzing, and reporting complaints, grievances, and appeals.

• Ability to draft response letters effectively.

• Competence in maintaining files on individual appeals and grievances.

• Skill in managing large volumes of documents efficiently.

• Commitment to compliance with all policies and standards.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase plans available.

• Tuition reimbursement offered.

• Paid time off provided.

• Paid holidays.

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

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

• Benefits may be subject to eligibility criteria for programs.