Job Description

Grievance and Appeals Coordinator

W2 Contract

Salary Range: $52,000 - $62,400 per year

Location: South San Francisco, CA - Hybrid Role

Job Summary:

As a Grievance and Appeals Coordinator, you will implement Grievance and Appeals processes by resolving complaints filed by members and their representatives, and provide back-up support to member services.

Duties and Responsibilities:

• Research and resolve member complaints for all lines of business, ensuring compliance with Grievance and Appeals policies and procedures.
• Maintain grievance and appeals case files in our database.
• Effectively communicate with members and providers verbally and in writing.
• Prepare summaries and write resolution letters for members, which include summarizing member complaints and steps taken to resolve complaints in clear and grammatically correct language.
• Attend and present cases at the bi-weekly Staff Grievance and Appeals Committee.
• Prepare files for appeals to regulatory agencies.
• Maintain current knowledge of all regulatory requirements for grievance and appeal processes.
• Provide necessary coverage in the call centers for member services as needed.

Requirements and Qualifications:

• Associate's degree in health, business, social sciences, or humanities is preferred.
• 2 years of experience working with Medi-Cal or Medicare in a managed care environment preferred. Work performing grievance and appeals processing preferred.
• Work experience in a call center, claims department, and/or other customer service position required.
• Proficient in Microsoft Office Suite applications, including Outlook, Word, Excel, Access, and PowerPoint.
• Knowledge of Medicare, Medi-Cal, Managed Care, and medical terminology is preferred.
• Able to work as part of a team and support team decisions.
• Effective verbal and written communication skills
• Adaptable to changes in requirements/priorities for daily and specialized tasks.
• Good at summarizing information clearly, thoroughly, and quickly in writing.
• Able to deal with difficult people and situations while providing quality customer service.
• Uses sound judgment, identifies next steps, and develops appropriate solutions.
• Can collaborate with multiple parties to solve problems and can solve problems independently.

Desired Skills and Experience

Health Insurance, Grievance and Appeals, customer service, Medicare, Medi-Cal, Microsoft Office

Bayside Solutions, Inc. is not able to sponsor any candidates at this time. Additionally, candidates for this position must qualify as a W2 candidate.

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