Grievance & Appeals Case Analyst

About the role

Partnership HealthPlan of California is seeking a Grievance & Appeals Case Analyst to investigate, manage, and resolve member grievances and appeals. This role is ideal for someone who enjoys problem-solving, conducting investigations, communicating with members, and managing a high-volume caseload in a fast-paced environment. Position located in Fairfield, CA or Redding, CA (100% Onsite).

Responsibilities

• Manage approximately 50-60 active grievance and appeal cases at a time.
• Investigate member concerns related to denied services, access to care, provider issues, customer service concerns, and health plan benefits.
• Gather documentation and evidence to support case investigations.
• Communicate directly with members regarding case status, next steps, and outcomes.
• Work closely with internal departments, providers, and external partners to resolve cases.
• Draft acknowledgment letters, resolution letters, and other case-related correspondence.
• Maintain accurate case documentation and ensure compliance with regulatory timelines and requirements.
• Handle sensitive and occasionally escalated member interactions with professionalism and empathy.

Qualifications

• Minimum of 1 year of experience in healthcare, health insurance, managed care, banking, finance, law enforcement, investigations, compliance, customer service, or a related field.
• Experience managing a high-volume workload or caseload.
• Strong written and verbal communication skills.
• Excellent customer service, investigative, and problem-solving abilities.
• Strong organizational skills and attention to detail.
• Proficiency with Microsoft Office (Word, Excel, Outlook).
• Health plan or managed care experience is preferred.
• Experience with Everest is a plus.
• Candidates selected to move forward will be required to complete Workplace Reasoning Assessment and Writing Assessment.

Benefits

• 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)

Pay

The pay range for this position is $36.00 - $36.00 per hour.

Schedule

Monday-Friday, 8:00 AM - 5:00 PM.