Grievance & Appeals Coordinator I - 210056

TEKsystems•Los Angeles, CA

7d•$23 - $23•Remote

About The Position

Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.

High school diploma or equivalent
2+ years grievance or appeals, claims or related managed care experience
Strong oral, written, and problem solving skills
2-3 years of experience in a similar role, preferably within appeals and grievances, healthcare administration, or customer service in a regulated environment.
researching skills

Associate’s degree
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
Experience working with complex cases or compliance-related tasks is highly desirable.

Gather, analyze and report verbal and written member and provider complaints, grievances and appeals
Prepare response letters for member and provider complaints, grievances and appeals
Maintain files on individual appeals and grievances
May coordinate the Grievance and Appeals Committee
Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information
Assist with HEDIS production functions including data entry, calls to provider’s offices, and claims research.
Manage large volumes of documents including copying, faxing and scanning incoming mail