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Grievance Resolution Specialist (Provider Resolution)

Aroha Technologies

Orange, CA

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JOB DETAILS
SKILLS
Administrative Skills, Analysis Skills, Communication Skills, Customer Support/Service, Detail Oriented, Farsi Language, Government Standards, Health Plan, Healthcare, Healthcare Administration, Healthcare Customer Service, High School Diploma, Korean Language, Maintain Compliance, Medi-Cal, Medicare, Microsoft Excel, Microsoft Office, Microsoft Outlook, Microsoft PowerPoint, Microsoft Word, Multilingual, Multitasking, Organizational Skills, Presentation/Verbal Skills, Problem Solving Skills, Process Improvement, Provider Contracting, Record Keeping, Regulations, Regulatory Compliance, Regulatory Requirements, Research Contracts, Russian Language, Team Player, Time Management, Trend Analysis, Vietnamese Language, Writing Skills
LOCATION
Orange, CA
POSTED
4 days ago
Grievance Resolution Specialist (Provider Resolution)

Job Title: Grievance Resolution Specialist (Provider Resolution)

Location: Orange County, CA (500 City Parkway West)

Job Type: Temporary Contract (Up to 6 Months)

Work Schedule: Monday Friday | 8:00 AM 5:00 PM

Work Setting: 100% Onsite

Job Overview

We are seeking a detail-oriented Grievance Resolution Specialist (Provider Resolution) to support the Grievance & Appeals department. In this role, you will investigate provider grievances and appeals, coordinate with internal teams, communicate with providers, and ensure timely, accurate case resolution while maintaining compliance with healthcare regulations.

Key Responsibilities
  • Review and process provider grievances and appeals.
  • Gather, analyze, and document case information.
  • Create and maintain accurate case records and reports.
  • Communicate with providers and internal departments regarding case status.
  • Research provider contracts, policies, and regulatory requirements.
  • Draft professional resolution letters and correspondence.
  • Respond to provider inquiries by phone and email.
  • Coordinate with operational teams to resolve complex issues.
  • Identify trends and recommend process improvements.
  • Maintain confidentiality and comply with healthcare regulations.
  • Perform additional administrative duties as assigned.
Minimum Qualifications
  • High School Diploma or GED.
  • At least 1 year of experience in one or more of the following:
    • Provider Dispute Resolution
    • Medicare or Medi-Cal Appeals
    • Grievance & Appeals
    • Claims Administration
    • Regulatory Compliance
    • Healthcare Customer Service
  • Strong written and verbal communication skills.
  • Ability to work independently and manage multiple priorities.
  • Proficiency in Microsoft Office (Word, Excel, Outlook, PowerPoint).
Preferred Qualifications
  • Associate degree in Business, Healthcare Administration, or a related field.
  • Experience with healthcare practice standards for government and commercial health plans.
  • Bilingual candidates (Spanish, Vietnamese, Chinese, Korean, Arabic, Farsi, or Russian) are encouraged to apply.
Skills
  • Strong analytical and problem-solving abilities
  • Excellent organizational skills
  • Attention to detail
  • Ability to manage multiple cases simultaneously
  • Professional customer service skills
  • Team-oriented with the ability to build positive working relationships

About the Company

A

Aroha Technologies

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