Grievance & Appeals Coordinator I

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

📋 Description

• Analyze and address verbal and written claims as well as authorization appeals from providers.

• Work towards resolving formal grievances raised by members.

• Collect, analyze, and report on complaints, grievances, and appeals from both members and providers.

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

• Maintain comprehensive files on individual appeals and grievances.

• May facilitate the Grievance and Appeals Committee.

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

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

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

• Carry out additional duties as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

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

• Must be located near Woodland Hills, California.

• High school diploma or equivalent is necessary.

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

• 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 options may be included in the overall compensation package.

• Equal opportunity employer dedicated to promoting diversity.