Grievance Resolution Specialist (Provider Resolution)
Grievance Resolution Specialist (Provider Resolution)
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Job Description
We are currently seeking a Temporary Grievance Resolution Specialist (Provider Resolution) to join our team and support our mission of delivering high-quality member-focused healthcare services.
This position plays a key role in coordinating the Grievance and Appeals resolution process responding to verbal and written inquiries from both members and providers related to eligibility benefits contract administration claims pharmacy vision and utilization management decisions.
Position Details:
Job Title: Temporary Grievance Resolution Specialist (Provider Resolution)
Department: GA Provider Disputes
PAY Range: $25/HR - $30/HR
Schedule: Monday Friday 8:00 AM 5:00 PM
Location: Orange CA 92868
Duration: Temporary Assignment for 6 months
Key Responsibilities Include:
Investigate and resolve provider grievances and appeals
Collaborate with internal teams (Customer Service Provider Relations Pharmacy Medical Management)
Review contracts DOFRs and policies to assess case details
Draft provider/member resolution letters and document case outcomes
Maintain accurate records in Healths systems
Ensure regulatory compliance and timely resolution
Minimum Qualifications:
High school diploma or equivalent
1 year of experience in Medicare/Medi-Cal provider appeals and denials
Experience in Grievances and Appeals Claims Compliance or related areas
Strong communication organizational and case management skills
Preferred Qualifications:
Associate degree in healthcare administration or related field
Bilingual in one of threshold languages (e.g. Spanish Vietnamese Korean)
Familiarity with provider dispute resolution and regulatory standards
If youre looking to make an impact in healthcare and bring resolution to complex provider issues in a dynamic and supportive environment wed love to hear from you.
Please let me know if youre interested and I will be happy to provide additional information on how to apply.
Best regards
Ashu
Senior Healthcare Recruiter
Direct: Aroha Technologies Inc.
#RN2025 #LPN2025 #CNA2025
Employment Type
Full-time
