Job Description

Grievance & Appeals Coordinator I

Location: Remote (California) - Candidates should live within reasonable distance of the Woodland Hills or Natomas offices
Schedule: Monday Friday, 8:00 AM 5:00 PM (overtime as needed; occasional weekends/holidays)
Duration: 12-month assignment with potential to extend or convert
Pay Rate: $23/hour

Position Summary

The Grievance & Appeals Coordinator supports the resolution of member and provider grievances and appeals by analyzing claims, authorizations, and formal complaints. This role ensures timely, accurate case handling while maintaining high quality and compliance standards.

Key Responsibilities

• Review, analyze, and resolve verbal and written grievances and appeals from members and providers

• Prepare clear, professional written response letters

• Maintain accurate files and documentation for all cases

• Track and manage large volumes of case-related documents

• Support committee coordination related to grievance and appeals processes

• Assist with quality initiatives, including performance tracking and reporting

• Support HEDIS-related activities such as data entry, provider outreach, and claims research

• Collaborate closely with team members to meet quality, accuracy, and turnaround benchmarks

Qualifications

Required:

• High school diploma or equivalent

• 2 3 years of experience in grievances and appeals, claims, healthcare administration, or a regulated healthcare environment

• Strong written, verbal, and problem-solving skills

• High attention to detail and ability to manage multiple cases simultaneously

Preferred:

• Associate's degree

• Knowledge of healthcare regulations (e.g., Medicare/Medicaid)

• Experience handling complex or compliance-related cases

• Strong letter-writing and documentation skills

• Conflict resolution or cross-functional coordination experience

Performance Expectations

• Meet or exceed 97% quality and accuracy standards

• Resolve cases efficiently while maintaining compliance and customer satisfaction

• Communicate effectively and collaborate across teams

Ideal Candidate Traits

• Detail-oriented and organized

• Professional, empathetic communicator

• Analytical and solution-focused

• Comfortable working independently in a remote environment while staying engaged with the team

CLIENT does not discriminate in employment on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other non-merit factor.

Job Tags

Remote work, Monday to Friday,

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