Job Type Onsite Full-Time Location Rancho Cucamonga, California Job Summary We are looking for a Grievance & Appeals Coordinator to support the processing and resolution of member and provider grievance and appeal cases in a managed healthcare environment. This role is responsible for coordinating administrative functions, ensuring cases are processed according to established guidelines, maintaining accurate documentation, and identifying issues that require escalation. The ideal candidate is bilingual in English and Spanish, highly organized, detail-oriented, and experienced in managed care, customer service, or grievance and appeals operations. Key Responsibilities Process and coordinate member and provider grievance and appeal cases. Perform administrative support functions for the Grievance & Appeals department. Maintain accurate documentation and case records. Ensure compliance with grievance and appeals policies, procedures, and timelines. Identify trends, deficiencies, or urgent cases and escalate them appropriately. Communicate professionally with members, providers, and internal departments. Monitor case status and assist with timely resolution. Support departmental reporting and other administrative activities as assigned. Qualifications Required High School Diploma or GED. Bilingual in English and Spanish (written and verbal). Minimum 3 years of administrative experience in an office environment. Experience using Microsoft Office Suite (Word, Excel, Outlook, etc.). Experience in a managed care member services or customer service environment. Strong organizational, communication, and interpersonal skills. Data entry experience and typing speed of 45 words per minute. Ability to manage multiple tasks and meet deadlines. Strong attention to detail and ability to follow policies and procedures. Preferred Bachelor's degree from an accredited institution. Experience with Medi-Cal and Medicare programs. Previous experience handling member and provider grievances and appeals. Skills Required Excellent verbal and written communication. Customer service and telephone etiquette. Microsoft Word and Excel proficiency. Time management and multitasking. Problem-solving and critical thinking. Ability to work independently and collaboratively in a team environment.
Not specified in the original listing.
Not specified in the original listing.
R.L. Klein & Associates Inc. specializes in providing healthcare staffing solutions, particularly in respiratory therapy services. The company focuses on delivering quality care within correctional healthcare facilities. Read More