Grievance & Appeals Coordinator I - 210056

The Grievance & Appeals Representative is responsible for analyzing and resolving verbal and written claims and authorization appeals from providers, as well as pursuing resolution of formal grievances from members. Responsibilities include gathering, analyzing, and reporting complaints, grievances, and appeals; preparing response letters; maintaining files; coordinating the Grievance and Appeals Committee; supporting pay-for-performance programs; assisting with HEDIS production functions; managing documents; and managing large volumes of documents.

About the role

• High school diploma or equivalent required; Associate’s degree preferred.
• 2+ years of experience in grievances, appeals, claims, or related managed care roles.
• Strong oral, written, and problem-solving skills.
• Must-have skills: 2–3 years of experience in appeals/grievances, healthcare administration, or customer service in a regulated environment; strong researching skills; experience handling complex cases or compliance-related tasks; understanding of medical terminology and insurance processes; professional phone etiquette.
• Nice-to-have skills: knowledge of healthcare regulations (Medicare/Medicaid compliance); conflict resolution skills with professionalism and empathy; project coordination experience in fast-paced environments; strong letter-writing skills.

Requirements

• Disqualifiers: job hopping, lack of experience in appeals/grievances or regulated environments, poor attention to detail, inadequate communication skills, weak problem-solving ability.

Pay and Benefits

The pay range for this position is $23.00 - $23.00/hr. 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 medical, dental & vision, critical illness, accident, and hospital coverage; 401(k) retirement plan; 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).

Job Type & Location

This is a Contract to Hire position based out of Los Angeles, CA.

Performance Indicators

• Accuracy and quality compliance: consistently meets/exceeds 97% quality standard.
• Efficiency and productivity: completes case reviews/resolutions ahead of deadlines.
• Effective collaboration and communication with management and cross-functional teams.
• Customer satisfaction: resolves member grievances effectively and professionally.

About TEKsystems

We are a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We are a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We are strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We are building tomorrow by delivering business outcomes and making positive impacts in our global communities.

San Francisco Fair Chance Ordinance

Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.