California Licensed Grievance Coordinator

Job Summary

A company is looking for a Grievance & Appeals Coordinator II.

Key Responsibilities

• Analyze and resolve grievances and appeals from providers and members in compliance with regulations
• Review claim grievances for reconsideration and prepare cases for medical review as necessary
• Act as a liaison between members, providers, and regulatory agencies, and lead the Appeals and Grievance Committee

Required Qualifications

• Bachelor's degree in a related field or equivalent experience
• 2+ years of claims, contracting, or related experience in a managed care environment
• Must reside in California
• Experience with grievance and appeals processes
• Knowledge of federal and state regulations related to grievances and appeals