Grievance & Appeals Coordinator I

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

📋 Description

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

• Actively seek resolutions for formal grievances submitted by members.

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

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

• Keep organized files for individual appeals and grievances.

• May facilitate the Grievance and Appeals Committee meetings.

• Assist pay-for-performance initiatives through data entry, tracking, organizing, and information research.

• Support HEDIS production activities, 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.

• Carry out other assigned duties as necessary.

• Adhere to all relevant policies and standards.

⛳️ Requirements

• High school diploma or equivalent.

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

• Applicants must be residents of California.

• Preferred background in healthcare, appeals, and/or behavioral health.

• Associate’s degree is preferred.

• Availability for overtime and weekend shifts may be necessary.

• Compliance with all relevant policies and standards is required.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase plans available.

• Tuition reimbursement offered.

• Paid time off along with holidays.

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

• Additional forms of incentives may be included in total compensation.