Grievance and Appeals Coordinator

Job Summary

Analyzing and resolving verbal and written claims and authorization appeals, the full-time Grievance and Appeals Coordinator will manage member and provider complaints, prepare response letters, and maintain files, all while working remotely from California.

Key responsibilities

• Gather, analyze, and report on member and provider complaints, grievances, and appeals
• Prepare response letters for complaints and maintain organized files on appeals and grievances
• Support pay-for-performance programs and assist with HEDIS production functions, including data entry and claims research

Required qualifications

• High school diploma or equivalent; associate's degree preferred
• 2+ years of experience in grievance or appeals, claims, or related managed care
• Authorization to work in the U.S. without the need for employment-based visa sponsorship
• Residence near Woodland Hills, CA