Grievance and Appeals Coordinator
$47,840–$58,240 year
On-siteSherman Oaks, California, United States
Job Summary
Receive, document, and track member grievances and appeals in accordance with regulatory guidelines. Investigate and coordinate resolution of complaints, appeals, and grievances while collaborating with clinical, provider relations, and compliance teams. Ensure adherence to state and federal regulatory requirements, including DMHC and CMS guidelines, and prepare written correspondence for members and providers. Maintain accurate case records, generate reports on activity and trends, and participate in quality improvement initiatives related to member satisfaction. This role supports MedPOINT Management's mission to coordinate quality care and operational excellence for Southern California providers and members, with flexible work-from-home options available.
Required Qualifications
- 2+ years of experience in grievance and appeals, managed care, or health plan operations
- 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
Desired Qualifications
- Strong knowledge of DMHC, CMS, and NCQA regulatory requirements preferred
- Associate's or Bachelor's degree in Healthcare Administration or a related field preferred
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