Appeals & Grievances Specialist I

Mitchell Martin Inc.; Los Angeles (CA); On-site; USD 76,106,000 - 95,132,000; Part time

Job summary

Mitchell Martin Inc. in Los Angeles, CA, is seeking an Appeals & Grievances Specialist I for an onsite contract role. The position focuses on managed care, Medicare and Medi-Cal with strict regulatory deadlines and case management responsibilities.

Excellent written communication and organizational skills are essential. The role requires experience in appeals and grievances, ability to draft resolution letters, and a solid understanding of CMS and DHCS regulations.

Qualifications

• 1 year of managed care experience with Medicare, Medi-Cal, and state programs.
• Direct experience in appeals and grievances.
• Ability to write resolution letters effectively.
• Strong knowledge of Medicare and Medi-Cal regulations.
• Proven case management skills with deadlines.
• Excellent written communication and organizational skills.
• High school diploma or GED required.

Responsibilities

• Manage appeals and grievances for members within regulatory deadlines.
• Communicate clearly with members, providers, and internal teams.
• Draft concise, well-structured resolution letters.
• Maintain thorough case files and documentation.
• Onsite role; Monday–Friday with Saturdays required.

Skills

Managed care

Grievances

Communication

Case management

Resolution letters

Regulatory knowledge

Education

High School diploma or GED

Associate's degree preferred

Job description

Title: Appeals & Grievances Specialist I

Location: Los Angeles, CA

Employment Type: Contract

Compensation

Pay Range: $26.56-$33.20 Per HR

Description

Join our team as an Appeals & Grievances Specialist I in Los Angeles, CA.

This onsite contract role requires expertise in managed care, specifically with Medicare and Medi-Cal.

The position demands excellent communication skills and the ability to manage cases within strict regulatory deadlines, working Monday through Friday with every Saturday required.

Requirements

• Minimum 1 year of managed care experience with Medicare, Medi-Cal, and state-sponsored programs.
• Direct experience in appeals and grievances.
• Ability to write resolution letters effectively.
• Strong knowledge of Medicare and Medi-Cal regulations.
• Proven case management skills with adherence to deadlines.
• Excellent written communication and organizational skills.
• High school diploma or GED.

Qualifications

• Associate's degree preferred.
• In-depth knowledge of CMS, DHCS, DMHC, and NCQA regulations.
• Experience with medical terminology and member advocacy.