Appeal and Grievance Coordinator
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Job Location:
Woodland Hills, CA - USA
Monthly Salary:
Not Disclosed
Posted on:
8 hours ago
Vacancies:
1 Vacancy
Job Summary
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
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
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Prepare clear professional written response letters
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Maintain accurate files and documentation for all cases
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Track and manage large volumes of case-related documents
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Support committee coordination related to grievance and appeals processes
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Assist with quality initiatives including performance tracking and reporting
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Support HEDIS-related activities such as data entry provider outreach and claims research
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Collaborate closely with team members to meet quality accuracy and turnaround benchmarks
Required:
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High school diploma or equivalent
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2 3 years of experience in grievances and appeals claims healthcare administration or a regulated healthcare environment
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Strong written verbal and problem-solving skills
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High attention to detail and ability to manage multiple cases simultaneously
Preferred:
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Associates degree
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Knowledge of healthcare regulations (e.g. Medicare/Medicaid)
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Experience handling complex or compliance-related cases
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Strong letter-writing and documentation skills
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Conflict resolution or cross-functional coordination experience
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Meet or exceed 97% quality and accuracy standards
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Resolve cases efficiently while maintaining compliance and customer satisfaction
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Communicate effectively and collaborate across teams
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Detail-oriented and organized
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Professional empathetic communicator
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Analytical and solution-focused
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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.
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