California Licensed 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 regulations
• Prepare and maintain case files and documentation for appeals and grievances
• Provide excellent customer service and support to internal and external customers

Required Qualifications

• 3 years of 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 commercial appeals and grievances
• Strong organizational skills and ability to manage multiple tasks concurrently