• Job Description

  Req#: 32510002792

  Grievance and Appeals Coordinator

  W2 Contract

  Salary Range: $52,000 - $62,400 per year

  Location: South San Francisco, CA - Hybrid Role

  Job Summary:

  As a Grievance and Appeals Coordinator, you will implement Grievance and Appeals processes by resolving complaints filed by members and their representatives, and provide back-up support to member services.

  Duties and Responsibilities:

  • Research and resolve member complaints for all lines of business, ensuring compliance with Grievance and Appeals policies and procedures.
  • Maintain grievance and appeals case files in our database.
  • Effectively communicate with members and providers verbally and in writing.
  • Prepare summaries and write resolution letters for members, which include summarizing member complaints and steps taken to resolve complaints in clear and grammatically correct language.
  • Attend and present cases at the bi-weekly Staff Grievance and Appeals Committee.
  • Prepare files for appeals to regulatory agencies.
  • Maintain current knowledge of all regulatory requirements for grievance and appeal processes.
  • Provide necessary coverage in the call centers for member services as needed.

  Requirements and Qualifications:

  • Associate's degree in health, business, social sciences, or humanities is preferred.
  • 2 years of experience working with Medi-Cal or Medicare in a managed care environment preferred. Work performing grievance and appeals processing preferred.
  • Work experience in a call center, claims department, and/or other customer service position required.
  • Proficient in Microsoft Office Suite applications, including Outlook, Word, Excel, Access, and PowerPoint.
  • Knowledge of Medicare, Medi-Cal, Managed Care, and medical terminology is preferred.
  • Able to work as part of a team and support team decisions.
  • Effective verbal and written communication skills
  • Adaptable to changes in requirements/priorities for daily and specialized tasks.
  • Good at summarizing information clearly, thoroughly, and quickly in writing.
  • Able to deal with difficult people and situations while providing quality customer service.
  • Uses sound judgment, identifies next steps, and develops appropriate solutions.
  • Can collaborate with multiple parties to solve problems and can solve problems independently.

  Desired Skills and Experience

  Health Insurance, Grievance and Appeals, customer service, Medicare, Medi-Cal, Microsoft Office

  Bayside Solutions, Inc. is not able to sponsor any candidates at this time. Additionally, candidates for this position must qualify as a W2 candidate.

  Bayside Solutions, Inc. may collect your personal information during the position application process. Please reference Bayside Solutions, Inc.'s CCPA Privacy Policy at .

• About the company

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