Job Description
Benefits:
- 401(k)
- 401(k) matching
- Company parties
- Dental insurance
- Employee discounts
- Free food & snacks
- Health insurance
- Opportunity for advancement
- Paid time off
- Parental leave
- Savings bank
- Training & development
- Vision insurance
- Wellness resources
About the Role:
MedPOINT Management in Sherman Oaks, CA is looking for a detail-oriented Grievance and Appeals Coordinator to join their dynamic healthcare team. In this critical role, you'll serve as a key advocate in ensuring member concerns are handled with care, compliance, and efficiency. If you're passionate about healthcare operations and making a real difference for patients, this is the opportunity for you.
Responsibilities:
- Receive, document, and track member grievances and appeals in accordance with regulatory guidelines
- Investigate and coordinate resolution of complaints, appeals, and grievances in a timely manner
- Collaborate with clinical, provider relations, and compliance teams to facilitate case resolution
- Ensure adherence to state and federal regulatory requirements, including DMHC and CMS guidelines
- Prepare and distribute written correspondence and resolution letters to members and providers
- Maintain accurate case records and generate reports on grievance and appeals activity and trends
- Participate in quality improvement initiatives related to member satisfaction and complaint reduction
Requirements:
- 2+ years of experience in grievance and appeals, managed care, or health plan operations
- Strong knowledge of DMHC, CMS, and NCQA regulatory requirements preferred
- Excellent written and verbal communication skills with strong attention to detail
- Proficiency in case management or healthcare information systems
- Ability to manage multiple cases simultaneously and meet strict deadlines
- Strong analytical and problem-solving skills with a member-first mindset
- Associate's or Bachelor's degree in Healthcare Administration or a related field preferred
About Us:
MedPOINT Management is a leading Independent Physician Association (IPA) management company based in Sherman Oaks, CA, with decades of experience supporting healthcare providers across Southern California. Providers and members trust MedPOINT for their commitment to quality care coordination, operational excellence, and innovative managed care solutions. Employees thrive in a collaborative, mission-driven environment where their work directly impacts the health and well-being of the communities they serve.
Flexible work from home options available.
Compensation: $23.00 - $28.00 per hour
Numbers & Facts
| Location | Sherman Oaks, California |
| Industry | Management Consulting Services |
| Company Size | 10,000 employees or more |
| Website | https://jobs.adp.com/life-at-adp/ |
About Company
ADP powers the working world with comprehensive solutions that drive business success. Consistently named one of the "Most Admired Companies" by FORTUNE® Magazine, and recognized by Forbes® as one of "The World's Most Innovative Companies," ADP has over a half-million clients around the globe and 65 years of experience as one of the largest providers of human capital management solutions world-wide.
At ADP, we believe that diversity fuels innovation. ADP is committed to equal employment opportunities regardless of race, color, genetic information, creed, religion, sex, sexual orientation, gender identity, lawful alien status, national origin, age, marital status, non-job related physical or mental disability, or protected veteran status. We support an inclusive workplace where associates excel based on personal merit, qualifications, experience, ability, and job performance.
Skills
- Analysis Skillsunmatched
- Case Managementunmatched
- Communication Skillsunmatched
- Content Management Systems (CMS)unmatched
- Dental Insuranceunmatched
- Detail Orientedunmatched
- Federal Laws and Regulationsunmatched
- Health Information Managementunmatched
- Health Insuranceunmatched
- Health Planunmatched
- Healthcareunmatched
- Healthcare Administrationunmatched
- Healthcare Providersunmatched
- Information Technology & Information Systemsunmatched
- Mail Processingunmatched
- Maintain Complianceunmatched
- Managed Careunmatched
- National Committee for Quality Assurance (NCQA)unmatched
- Operations Planningunmatched
- Organizational Skillsunmatched
- Presentation/Verbal Skillsunmatched
- Problem Solving Skillsunmatched
- Provider Relationsunmatched
- Quality Assuranceunmatched
- Quality Managementunmatched
- Record Keepingunmatched
- Regulationsunmatched
- Regulatory Requirementsunmatched
- Reporting Skillsunmatched
- Savings Bankunmatched
- State Laws and Regulationsunmatched
- Team Playerunmatched
- Time Managementunmatched
- Training/Teachingunmatched
- Vision Planunmatched
- Writing Skillsunmatched
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