Job Description
Job Description
Title: Appeals and Grievances Coordinator
Location: Remote, California – Must Reside Within Commuting Distance of either Natomas/Sacramento, CA or Woodland Hills, CA
Pay: $23/Hour
Schedule: Monday Through Friday, 8:00 AM To 5:00 PM PST; Overtime As Needed
Appeals and Grievances Coordinator Position Summary
This remote Healthcare Appeals and Grievances Coordinator role supports the processing and resolution of member appeals and grievances for a large managed care organization. The position is responsible for ensuring cases are handled accurately, thoroughly, and within required timeframes while maintaining high quality standards. The coordinator works closely with members and internal teams, supports complex cases, and contributes to initiatives focused on improving operational efficiency and the member experience.
The role requires strong attention to detail, research skills, problem-solving ability, and clear written and verbal communication. Coordinators will work collaboratively with the team to maintain quality standards, identify opportunities for process improvement, and ensure cases are properly documented and handled in accordance with applicable requirements.
Appeals and Grievances Coordinator Responsibilities
- Process and resolve member appeals and grievances accurately and within established timeframes.
- Research information related to member cases and use available resources to support appropriate case resolution.
- Collaborate with members and internal team members throughout the appeals and grievances process.
- Maintain clear and accurate documentation related to assigned cases.
- Handle complex cases and compliance-related tasks with attention to detail and accuracy.
- Communicate clearly and professionally when addressing sensitive member concerns.
- Identify opportunities to improve operational efficiency and the overall member experience.
- Support continuous improvement initiatives and team projects as needed.
- Work collaboratively with cross-functional teams to resolve issues and support business objectives.
- Maintain quality standards while managing multiple cases and competing priorities.
- Work Monday through Friday from 8:00 AM to 5:00 PM PST, with required overtime as needed when advance notice is provided.
- Work occasional Saturdays and holidays when needed, with schedules communicated at least 3-4 weeks in advance.
Appeals and Grievances Coordinator Training
- Training is an 8-week classroom-based course.
- Training schedule is Monday through Friday, 8:00 AM to 4:30 PM PST.
- Training includes a 30-minute lunch break each day.
- Successful completion of training is required before transitioning into the regular work schedule.
Appeals and Grievances Coordinator Qualifications
- High School Diploma required.
- 2-3 years of experience in appeals and grievances required.
- Experience working with complex cases or compliance-related tasks.
- Strong researching skills.
- Strong attention to detail and accuracy when reviewing and processing cases.
Appeals and Grievances Coordinator Preferred Qualifications
- Associate’s Degree preferred.
- Knowledge of healthcare regulations, health plan compliance, or regulatory requirements.
- Experience with Medicare and/or Medicaid guidelines.
- Experience handling sensitive cases and resolving conflicts with professionalism and empathy.
- Project coordination experience in a fast-paced environment.
- Strong letter writing and written communication skills.
- Previous experience working in appeals and grievances within a healthcare, insurance, or other regulated environment.
Appeals and Grievances Coordinator Additional Information
- Candidates must reside within commuting distance to either the Natomas/Sacramento, CA or Woodland Hills, CA company hub.
- The position is primarily remote, but workers may be required to report to the company hub on rare occasions for team meetings or company events.
- Overtime may be required based on business needs. Advance notification will be provided.
- Occasional Saturday and holiday work may be required, with at least 3-4 weeks of advance notice.
- Candidates with multiple short-term positions should clearly identify when a position was a contract assignment and whether the assignment was completed.
- This position is intended for candidates who are serious about the opportunity and interested in potential conversion to a full-time employee based on business needs and performance.
- Strong attention to detail is essential, as inaccuracies or errors in case handling can affect quality standards.