Grievance Resolution Specialist (Provider Resolution) Healthcare

Orange, CA - USA

Monthly Salary: Not Disclosed

Posted on: 16-10-2025

Vacancies: 1 Vacancy

Job Summary

#LPN2025

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 CalOptima 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 CalOptimas 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

Ayushi kaushik

Healthcare Recruiter

Direct: 510.660.6056

Email:
5000 Hopyard RD Suite 415
Pleasanton CA 94568

#LPN2025 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 proces...