Job Summary

Grievance & Appeals Coordinator

  • Location:
    Cerritos, California
  • Job reference:
    US_EN_3_108035_322785
  • Category:
    Customer Service (non-IT)
  • Contract Type:
    Contract/Temporary

A Grievance and Appeals Coordinator job in Cerritos, CA is available through Modis Engineering and Information Technology. You will be responsible for summarizing and presenting essential information for the clinical specialist or medical/dental director and legal counsel. This contract job is anticipated to start immediately.

Grievance and Appeals Coordinator job responsibilities include:

We are looking for experience candidates to work in our Client’s Appeals & Grievance dept. who will responsible for processing both appeals and grievances for a Medicare Advantage Health Plan (high compliant area). Responsible for investigating and reviewing customer grievances and appeals regarding provision of service and benefit coverage issues. Triages clinical and non-clinical inquiries, grievances and appeals, prepares case files for member grievance committees/hearings.

Responds to oral and written complaints sent to the Office of the Chairman, President or Vice President complaints. Ensures appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either regulatory/accreditation agencies or customer needs. Contacts members to gather information and communicate disposition of case; documents interactions. Generates written correspondence to members, providers and regulatory agencies. Identifies barriers to customer satisfaction and recommends actions to address operational challenges. Pursues ongoing education/training on benefits/services to ensure accurate resolution of grievances and appeals, and overall industry knowledge and development (i.e. HIAA, LOMA, etc.). Operates a PC/image station to obtain and extract information; documents information, activities and changes in the database.

QUALIFICATIONS:

HS Diploma or equivalent (required).
Previous experience working in a customer service environment – required.
Preferred previous experience working in medical appeals and/or grievances.
Must have excellent communication skills, inter-personal skills, and strong attention to details – required.
Ability to manage multiple projects and deadlines simultaneously.
Someone who is a self-starter, quick learner, excellent organization and time management.
Sound judgment and decision-making abilities.
Ability to process complex information quickly and thoroughly.
Computer skills including working knowledge of Microsoft Word, Excel, and Access.

If you are interested in this Grievance and Appeals Coordinator job in Cerritos, CA then please click APPLY NOW. If you have questions about this position, please contact Amy Alix via e-mail: amy.alix@modis.com.

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All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.

Equal employment opportunity information:
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