Immediate need for a talented
Health Plan Appeals & Grievances Coordinator (California). This is a
06+ Months Contract opportunity with long-term potential and is located in
US (Remote). Please review the job description below and contact me ASAP if you are interested.
Job ID:26-21736
Pay Range: $27 - $31/hour. Traveler benefits as per agency package. (Benefits vary by vendor and assignment.)
Key Responsibilities:- We are seeking a detail-oriented Case Manager – Appeals & Grievances to investigate, coordinate, and resolve member complaints, grievances, and appeals in compliance with health plan and regulatory standards.
- This role ensures timely and fair resolutions, accurate documentation, and strong cross-functional collaboration.
Key Requirements and Technology Experience:- 2+ years experience in Appeals, Grievances, Utilization Management, or Care Coordination in a health plan or TPA.
- Strong understanding of CMS, DMHC, and NCQA regulatory standards.
- 5+ years of Appeals & Grievances experience within a Health Plan or Managed Care organization
- Experience handling:
- Member Appeals
- Provider Appeals
- Claims Denials
- Authorization Appeals
- Benefit Determinations
- Knowledge of:
- CMS
- DMHC
- NCQA
- Medicare
- Medi-Cal
- Commercial Health Plans
- Excellent written communication skills
- Experience reviewing medical records and clinical documentation
Our client is a leading
Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
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