Grievance And Appeals Coordinator

TEKsystems; Long Beach (CA); Remote; USD 80,000 - 100,000; Full time

Job summary

A technology services company is looking for a Grievance and Appeals Specialist to facilitate the member grievance process. The role involves investigating cases, documenting information, and ensuring compliance with regulatory standards. Candidates must have a High School Diploma and 2 years of experience in grievances and appeals within healthcare. This is a fully remote position with a pay rate of $24.00/hr.

Benefits

Medical, dental & vision benefits

401(k) Retirement Plan

Employee Assistance Program

Qualifications

• 2 years of experience within grievances and appeals in a healthcare setting.
• Ability to track and monitor cases through functional units.

Responsibilities

• Investigates member grievance and appeal by gathering supporting documentation.
• Tracks and monitors movement of assigned cases through systems.
• Responds to requests for information from regulatory agencies.

Skills

Experience within grievances and appeals

Documenting and preparing case files

Communicating with members or providers

Education

High School Diploma

Job description

Overview

Remote but must reside in CA, AZ, TX, NM, or NV.

Job Purpose

Facilitates the member grievance and appeal process by investigating, documenting and preparing case files to meet all regulatory requirements.

Responsibilities

• Investigates member grievance and appeal by gathering supporting documentation from internal departments, contracted Provider Organizations (PO), and non-contracted entities as indicated.
• Communicates with the members or providers to request and gather pertinent information. Follows up as needed and documents accordingly.
• Refers case to RN or management as needed.
• Tracks and monitors movement of assigned cases through functional units and systems, to ensure compliance with designated timelines.
• Responds to requests for information from all regulatory agencies within required timeframes.
• Responds to and closes cases within designated regulatory time requirements as identified by case types. Generates and sends appropriate communications.
• Understands benefit structure and maintains current and additional information as it relates to Grievances and Appeals services.
• Utilizes department desktop procedures, workflows, job aids and training material. Identifies barriers to work processes and brings to the attention of the supervisor/manager.
• Covers week-end on-call rotation as assigned.
• Maintains the member's right to privacy and protects operations by keeping information confidential.
• Adheres to all quality, compliance and regulatory standards to achieve HCS and outcomes.
• Actively supports the achievement of vision and Goals.
• Contributes to team effort by accomplishing related results as needed.
• Actively supports the achievement of Vision and Goals.

Qualifications

• High School Diploma, Required
• 2 years of experience within grievances and appeals in a healthcare setting
• Experience Level: Expert Level

Pay and Benefits

• The pay range for this position is $24.00 - $24.00/hr.
• Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms.
• Benefits may include Medical, dental & vision; Critical Illness, Accident, and Hospital; 401(k) Retirement Plan; Life Insurance; Short and long-term disability; Health Spending Account; Transportation benefits; Employee Assistance Program; Time Off/Leave.

Workplace Type

This is a fully remote position.

Application Deadline

This position is anticipated to close on Oct 21, 2025.

About TEKsystems

We\'re partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That\'s the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

About TEKsystems and TEKsystems Global Services

We\'re a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We\'re a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We\'re strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We\'re building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.