Grievance & Appeals Case Analyst

TEKsystems•Fairfield, CA

6d•$36 - $36•Hybrid

About The Position

Partnership HealthPlan of California is seeking a Grievance & Appeals Case Analyst to investigate, manage, and resolve member grievances and appeals. This role is ideal for someone who enjoys problem-solving, conducting investigations, communicating with members, and managing a high-volume caseload in a fast-paced environment.

Requirements

Minimum of 1 year of experience in healthcare, health insurance, managed care, banking, finance, law enforcement, investigations, compliance, customer service, or a related field.
Experience managing a high-volume workload or caseload.
Strong written and verbal communication skills.
Excellent customer service, investigative, and problem-solving abilities.
Strong organizational skills and attention to detail.
Proficiency with Microsoft Office (Word, Excel, Outlook).

Nice To Haves

Health plan or managed care experience is preferred.
Experience with Everest is a plus.

Responsibilities

Manage approximately 50-60 active grievance and appeal cases at a time.
Investigate member concerns related to denied services, access to care, provider issues, customer service concerns, and health plan benefits.
Gather documentation and evidence to support case investigations.
Communicate directly with members regarding case status, next steps, and outcomes.
Work closely with internal departments, providers, and external partners to resolve cases.
Draft acknowledgment letters, resolution letters, and other case-related correspondence.
Maintain accurate case documentation and ensure compliance with regulatory timelines and requirements.
Handle sensitive and occasionally escalated member interactions with professionalism and empathy.