Grievance & Appeals Coordinator I

Immediate need for a talented Grievance & Appeals Coordinator I. This is a 12 Months Contract opportunity with long-term potential and is located in Woodland Hills CA or Sacramento CA PST(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID:25-60840

Pay Range: $21 - $22/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• A typical day in the role of a Case Coordinator for Appeals and Grievances involves processing and resolving member appeals and grievances, ensuring each case is handled with accuracy and timeliness.
• The coordinator collaborates closely with the member and team on cases, providing essential support and maintaining clear communication throughout the process.
• The role also involves contributing to continuous improvement initiatives, identifying opportunities to enhance operational efficiency and customer satisfaction.
• Daily tasks require a keen attention to detail, effective problem-solving, and teamwork within a supportive and collaborative environment.
• The coordinator will be required to work Monday through Friday 8am to 5pm with overtime as need and occasional Saturdays/holidays.
• This Case Coordinator role in Appeals and Grievances is uniquely rewarding, offering the opportunity to make a meaningful impact on member experiences while working within a supportive and collaborative team culture.
• Our team is dedicated to continuous improvement, encouraging curiosity, problem-solving, and personal growth.
• The role provides exposure to complex cases, enhancing analytical and communication skills, and offers the chance to work closely with cross-functional teams.
• Joining us means being part of a dynamic environment that values customer care, operational excellence, and professional development, making it an ideal role for those seeking both challenge and growth.
• The role provides exposure to complex cases, enhancing analytical and communication skills, and offers the chance to work closely with cross-functional teams.
• Joining us means being part of a dynamic environment that values customer care, operational excellence, and professional development, making it an ideal role for those seeking both challenge and growth.

Key Requirements and Technology Experience:

• Skills-Grievance & Appeals Coordinator , Case Coordinator.
• High School diploma or GED.
• Microsoft 365, Genesys.
• Required: 2 years grievance or appeals, claims or related managed care experience
• 2-3 years of experience in a similar role, preferably within appeals and grievances, healthcare administration, or customer service in a regulated environment.
  Experience working with complex cases or compliance-related tasks is highly desirable.
• Knowledge of Healthcare Regulations – Understanding of health plan compliance, regulatory requirements, or experience with Medicare/Medicaid guidelines.
• Conflict Resolution Skills – Ability to handle sensitive cases with professionalism and empathy.
• Project Coordination Experience – Exposure to coordinating cross-functional projects or initiatives in a fast-paced environment.
• Good Letter writing skills
• Performance indicators: Accuracy and Quality Compliance – Consistently meets or exceeds the 97% quality standard with minimal errors.
• Efficiency and Productivity – Completes case reviews and resolutions ahead of deadlines while maintaining high standards.
• Effective Collaboration and Communication – Proactively collaborates with the management team and cross-functional departments, contributing to positive team dynamics and problem-solving.
• Customer Satisfaction and Resolution – Resolves member grievances effectively, contributing to high customer satisfaction ratings.

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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