This position will provide resolution of complaints in compliance with Centers for Medicare and Medicaid Services (CMS), California Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), Managed Risk Medical Insurance Board (MRMIB), and National Committee for Quality Assurance (NCQA) regulatory requirements. The organization is committed to providing accessible, high-quality care and administrative services to its members, employing professionals across managed care, appeals and grievances, utilization management, claims processing, and member services functions.