Grievance And Appeals Coordinator

Fairfield, CA or Redding, CA (Fully Onsite)

About the role

Investigate member concerns, review appeals related to healthcare services and benefits, collaborate with clinical and operational teams, and help ensure members receive clear, timely resolutions. This position is ideal for someone who combines strong analytical skills with a passion for customer service and healthcare advocacy.

Responsibilities

• Investigate member grievances and appeals regarding healthcare services, benefits, and coverage decisions
• Gather and analyze information from providers, internal departments, and other stakeholders to reach fair and accurate resolutions
• Review denied services or benefits, collect additional documentation, and reassess cases as appropriate
• Communicate with members throughout the investigation process, providing updates and support
• Identify root causes of issues and recommend solutions to improve the member experience
• Draft clear, professional correspondence to members and providers in compliance with regulatory requirements
• Manage a caseload while ensuring all investigations are completed within required timelines
• Maintain accurate and thorough documentation of all case activities
• Partner closely with clinical staff, providers, regulatory agencies, and cross-functional teams
• Assist in identifying recurring trends and opportunities for process improvement
• Provide guidance and support to team members involved in the case review process
• Participate in department meetings, case conferences, and collaborative discussions

Requirements

• Strong investigative, analytical, and problem-solving skills
• Excellent written and verbal communication abilities
• Ability to manage multiple priorities and meet strict deadlines
• Experience handling sensitive or complex customer concerns with professionalism and empathy
• Strong attention to detail and organizational skills
• Ability to work independently while collaborating effectively with a team
• Experience in healthcare, managed care, health insurance, appeals, grievances, case management, compliance, customer advocacy, or a related field is highly preferred

Pay

$35.00 - $36.50/hr

Benefits

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

Schedule

This is a fully onsite, contract position based in Fairfield, CA.