GRIEVANCE AND APPEALS SPECIALIST

Job Description

Job Description

Job Summary
We are seeking Grievance and Appeals Specialists who enjoy research, documentation, regulatory accuracy, and clear written communication in a structured healthcare environment. This opportunity offers structured training, exposure to multiple health plan products, cross-functional collaboration, and a supportive team environment focused on compliance, quality, and member experience.

Key Responsibilities:
- Review, analyze, and process non-complex healthcare grievances and appeals from members, providers, regulatory entities, and third parties.
- Research grievance and appeal issues using established guidelines, review tools, claims data, provider network information, and medical records.
- Prepare clear written determination communications that meet regulatory, accreditation, and internal policy requirements.
- Route appropriate cases to nursing, medical management, legal, service operations, or other internal teams for additional review.
- Ensure case handling aligns with URAC, NCQA, regulatory, and departmental standards.
- Serve as a liaison between grievance and appeals teams and internal business partners as needed.

- Pay rate: $27 to $27.20 per hour.
- Job type: Contract/Temporary.
- Location: Irvine, CA. Must reside within 50 miles of Costa Mesa, CA.
- Flexible PST schedule options available after training: 7:30 a.m. to 4:00 p.m., 8:00 a.m. to 4:30 p.m., or 9:00 a.m. to 5:30 p.m.

Equal Opportunity Employer / Disabled / Protected Veterans

The Know Your Rights poster is available here:

-06/22-088_EEOC_KnowYourRights6.12.pdf

The pay transparency policy is available here:

- transp_%20English_formattedESQA508c.pdf

For temporary assignments lasting 13 weeks or longer, the Company is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.

We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.

AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.

verify.uscis.gov/web/media/resourcesContents/E - Verify_Participation_Poster_ES.pdf

We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

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\nCompany Description

This company offers growth and a great group of people to work with.

Company Description

This company offers growth and a great group of people to work with.