Appeals & Grievance Manager

Immediate need for a talented Appeals & Grievance Manager. This is a 12 months contract opportunity with long-term potential and is located in Corona, CA(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID: 26-17160

Pay Range: $30/hr - $32/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Resolve member grievance and appeals cases, with a focus on healthcare coverage issues.
• Investigated and resolved member and provider grievances and appeals in alignment with CMS, DMHC, and NCQA regulatory guidelines.
• Drafted and issued clear, accurate, and timely written determinations, ensuring compliance with state and federal requirements.
• Collaborated with compliance, legal, and clinical teams to ensure all case reviews met regulatory and quality standards.
• Prioritized and managed a high-volume caseload, consistently meeting strict regulatory timelines for resolution.
• Maintained detailed documentation of case activities to support audits, reporting, and quality assurance reviews.
• Identified trends in appeal outcomes and provided feedback to improve policies, processes, and compliance performance.

Key Requirements and Technology Experience:

• Key skills; Experience in Appeals & Grievances
• Experience in Case Management
• 5 years of recent experience in:
• Healthcare case management
• Grievance and appeals handling
• Letter Writing
• Strong analytical and critical thinking abilities
• Excellent documentation and written communication skills
• Strong interpersonal and listening skills; able to work with real people in real situations
• Comfortable with member-facing roles and handling complaint resolution
• Must be a team player and adaptable to change
• Knowledge of Healthcare Exchange programs
• Experience working with Excel and spreadsheets (Intermediate level preferred)
• Typing speed of 30 WPM
• Previous experience in healthcare insurance and claims resolution

Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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