Grievance And Appeals Coordinator

TEKsystems•Los Angeles, CA

2d•$23 - $23•Remote

About The Position

The Grievances and Appeals Coordinator analyzes and resolves verbal and written claims, authorizations, complaints, grievances, and appeals from members and providers in a regulated healthcare environment. This role ensures timely, accurate, and compliant resolution of cases, supports performance and quality programs, and contributes to continuous improvement in member and provider experience through strong communication, documentation, and analytical skills.

Requirements

High school diploma or equivalent required; associate degree preferred.
2+ years of experience in appeals & grievances, claims, managed care, healthcare administration, or customer service.
Strong written and verbal communication skills.
Excellent attention to detail and accuracy.
Proficiency with digital tools, case management systems, and office software.
Strong analytical, research, troubleshooting, and problem-solving abilities.
Ability to manage high workloads and maintain organization in a fast-paced environment.
Comfortable working remotely and collaborating with cross-functional teams.
Commitment to quality, compliance, and maintaining high accuracy standards (97%+).

Nice To Haves

Associate’s degree in a related field is preferred.
Experience working with complex cases or compliance-related tasks in healthcare, insurance, or other regulated environments.

Responsibilities

Analyze and resolve verbal and written claims, authorization appeals, complaints, grievances, and appeals from members and providers.
Gather, analyze, and report data related to member and provider complaints, grievances, and appeals to support compliance and quality standards.
Prepare clear, professional response letters addressing member and provider complaints, grievances, and appeals.
Complete case reviews and resolutions within required timelines while maintaining high quality standards and attention to detail.
Contribute to continuous improvement initiatives by identifying trends, issues, and opportunities to enhance grievance and appeals handling.