Health Plan Appeals & Grievances Coordinator (California)

Pyramid Consulting, Inc

🇺🇸 United States

Remote

Manager or above

2 months ago

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Immediate need for a talentedHealth Plan Appeals & Grievances Coordinator (California). This is a06+ Months Contract opportunity with long-term potential and is located in US (Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID:26-21736

Pay Range: $27 - $31/hour. Traveler benefits as per agency package. (Benefits vary by vendor and assignment.)

Key Responsibilities:

We are seeking a detail-oriented Case Manager – Appeals & Grievances to investigate, coordinate, and resolve member complaints, grievances, and appeals in compliance with health plan and regulatory standards.
This role ensures timely and fair resolutions, accurate documentation, and strong cross-functional collaboration.

Key Requirements and Technology Experience:

2+ years experience in Appeals, Grievances, Utilization Management, or Care Coordination in a health plan or TPA.
Strong understanding of CMS, DMHC, and NCQA regulatory standards.
5+ years of Appeals & Grievances experience within a Health Plan or Managed Care organization
Experience handling:
Member Appeals
Provider Appeals
Claims Denials
Authorization Appeals
Benefit Determinations
Knowledge of:
CMS
DMHC
NCQA
Medicare
Medi-Cal
Commercial Health Plans
Excellent written communication skills
Experience reviewing medical records and clinical documentation

Our client is a leadingHealthcare 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.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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Health Plan Appeals & Grievances Coordinator (California) · Pyramid Consulting, Inc

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