Grievance & Appeals Coordinator I - 210056

Grievance & Appeals Coordinator I - 210056

BC Forward is looking for Grievance & Appeals Coordinator I (Remote CA)

Position Title: Grievance & Appeals Coordinator I (Remote CA)
Location: Woodland Hills, CA, 91367 / Sacramento, CA 95834
Anticipated Start Date: 02/02
Duration: 12-months
Job Type: Contract with potential for extension
Shift: Monday through Friday, 8:00 AM-5:00 PM, with overtime as needed, including occasional Saturdays and holidays.
Pay Rate: $23.00/hour (W2)
Need: 2-3 years of relevant experience (preferably in appeals, grievances, healthcare administration, or regulated customer service), with demonstrated ability in complex case handling, compliance tasks, strong letter-writing, healthcare regulations, conflict resolution, and project coordination in fast-paced, cross-functional environments.
Interview Process: 1-Phone Screen, 2-Virtual/ InPerson Round


Job Description:
Grievance & Appeals Coordinator I
Position Purpose
Analyze and resolve verbal and written claims and authorization appeals from providers, and pursue resolution of formal grievances submitted by members.

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Education & Experience

• High school diploma or equivalent (required)
  
• Associate's degree (preferred)
  
• 2+ years of experience in grievances and appeals, claims, or related managed care roles
  
• Strong oral, written, and problem-solving skills
  

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Key Responsibilities

• Gather, analyze, and report verbal and written complaints, grievances, and appeals from members and providers
  
• Prepare clear, accurate response letters for member and provider complaints, grievances, and appeals
  
• Maintain organized files for individual appeals and grievances
  
• Coordinate the Grievance and Appeals Committee, as needed
  
• Support pay-for-performance programs, including data entry, tracking, organization, and research
  
• Assist with HEDIS production activities, including data entry, provider outreach, and claims research
  
• Manage large volumes of documents, including copying, faxing, scanning, and processing incoming mail
  

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Work Schedule & Overtime

• Monday through Friday, 8:00 AM - 5:00 PM
  
• Overtime as needed
  
• Occasional Saturdays and holidays
  

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Story Behind the Need - Business Group & Key Projects
We are seeking a Coordinator for Health Net Appeals and Grievances to join our dynamic team. This role is critical in supporting our commitment to maintaining quality measures that meet or exceed 97%.
The coordinator will collaborate closely with the team on case resolution, contribute to continuous improvement initiatives, and help enhance overall customer experience. Our team culture is supportive and collaborative, with a strong focus on customer care, curiosity, and operational efficiency.
This role offers growth potential within a high-performing team dedicated to excellence and long-term business success.

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Typical Day in the Role
A typical day involves processing and resolving member appeals and grievances while ensuring accuracy, timeliness, and compliance with quality standards. The coordinator works closely with team members and stakeholders, maintaining clear communication throughout each case.
Daily responsibilities also include contributing to continuous improvement initiatives, identifying opportunities to improve efficiency, and supporting customer satisfaction efforts. The role requires strong attention to detail, effective problem-solving skills, and active collaboration in a supportive team environment.
Schedule: Monday through Friday, 8:00 AM - 5:00 PM, with overtime as needed and occasional Saturdays or holidays.

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Compelling Story & Candidate Value Proposition
This Case Coordinator role in Appeals and Grievances offers a meaningful opportunity to positively impact member experiences while working within a collaborative and supportive team culture.
The team values curiosity, continuous improvement, and professional growth. The role provides exposure to complex cases, strengthening analytical, communication, and problem-solving skills, while offering opportunities to work cross-functionally across the organization.
This position is ideal for candidates seeking both professional challenge and career development in a dynamic healthcare environment focused on customer care and operational excellence.

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Candidate Requirements
Education

• Required: High school diploma
  
• Preferred: Associate's degree
  

Licensure

• Required: None
  
• Preferred: None
  

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Must-Have Qualifications

• 2-3 years of experience in a similar role, preferably in appeals and grievances, healthcare administration, or customer service within a regulated environment
  
• Experience handling complex cases or compliance-related tasks
  
• Strong letter-writing skills
  

Nice-to-Have Qualifications

• Knowledge of healthcare regulations, including health plan compliance or Medicare/Medicaid guidelines
  
• Conflict resolution skills with the ability to handle sensitive cases professionally and empathetically
  
• Project coordination experience in a fast-paced or cross-functional environment
  

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Disqualifiers

• Lack of experience in appeals, grievances, or regulated environments such as healthcare or insurance
  
• Poor attention to detail resulting in inaccuracies or errors
  
• Ineffective communication skills
  
• Limited problem-solving ability or inability to contribute to continuous improvement initiatives
  

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Performance Indicators

• Accuracy and Quality Compliance: Consistently meets or exceeds the 97% quality standard
  
• Efficiency and Productivity: Resolves cases ahead of deadlines while maintaining accuracy
  
• Collaboration and Communication: Actively partners with management and cross-functional teams
  
• Customer Satisfaction: Effectively resolves grievances, contributing to high satisfaction ratings
  

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Top 3 Must-Have Hard Skills (Ranked)

Attention to detail and accuracy

Strong communication and collaboration skills

Analytical and problem-solving skills

Interested candidates please send resume in Word format Please reference job code 248579 when responding to this ad.

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