California Appeals Coordinator

Job Summary

A company is looking for an Appeals/Grievance Coordinator I.

Key Responsibilities

• Investigate, document, and resolve member appeals and grievances in compliance with relevant laws and guidelines
• Prepare and maintain case files and documentation for appeals and grievances
• Provide excellent customer service and support to internal and external stakeholders

Required Qualifications

• 3 years' experience in claims, utilization review, appeals, or member services in a managed care environment
• Bachelor's degree in business administration or health care administration is preferred
• Thorough understanding of managed care principles and health services delivery models
• Familiarity with regulatory agency standards related to appeals and grievances
• Ability to analyze data and prepare summary reports from findings