Grievance & Appeals Case Analyst

TEKsystems; Fairfield (CA); Hybrid; USD 41,000 - 58,000; Full time

Benefits offered by this job

Medical dental & vision

401(k) plan

Life insurance

Paid time off

Job summary

Partnership HealthPlan of California seeks a Grievance & Appeals Case Analyst to investigate, manage, and resolve member grievances and appeals. You will handle a high-volume caseload, gather evidence, and communicate case status with members in a fast-paced environment.

The role requires strong investigative and communication skills, attention to detail, and proficiency with Microsoft Office. This is an onsite, contract position located in Fairfield, CA.

Qualifications

• Minimum of 1 year of experience in healthcare, health insurance, managed care, banking, finance, law enforcement, investigations, compliance, customer service, or a related field.
• Experience managing a high-volume workload or caseload.
• Strong written and verbal communication skills.
• Excellent customer service, investigative, and problem-solving abilities.
• Strong organizational skills and attention to detail.
• Proficiency with Microsoft Office (Word, Excel, Outlook).
• Health plan or managed care experience is preferred.
• Experience with Everest is a plus.

Responsibilities

• Manage approximately 50-60 active grievance and appeal cases at a time.
• Investigate member concerns related to denied services, access to care, provider issues, customer service concerns, and health plan benefits.
• Gather documentation and evidence to support case investigations.
• Communicate directly with members regarding case status, next steps, and outcomes.
• Work closely with internal departments, providers, and external partners to resolve cases.
• Draft acknowledgment letters, resolution letters, and other case-related correspondence.
• Maintain accurate case documentation and ensure compliance with regulatory timelines and requirements.
• Handle sensitive and occasionally escalated member interactions with professionalism and empathy.

Skills

Investigation skills

Communication

Organizational skills

Problem solving

High-volume workload management

Tools

Microsoft Office

Job description

Fairfield, CA or Redding, CA (100% Onsite)

$36.00/hour

Monday-Friday | 8:00 AM - 5:00 PM

Position Overview

Partnership HealthPlan of California is seeking a Grievance & Appeals Case Analyst to investigate, manage, and resolve member grievances and appeals. This role is ideal for someone who enjoys problem-solving, conducting investigations, communicating with members, and managing a high-volume caseload in a fast-paced environment.

Responsibilities

• Manage approximately 50-60 active grievance and appeal cases at a time.

• Investigate member concerns related to denied services, access to care, provider issues, customer service concerns, and health plan benefits.

• Gather documentation and evidence to support case investigations.

• Communicate directly with members regarding case status, next steps, and outcomes.

• Work closely with internal departments, providers, and external partners to resolve cases.

• Draft acknowledgment letters, resolution letters, and other case-related correspondence.

• Maintain accurate case documentation and ensure compliance with regulatory timelines and requirements.

• Handle sensitive and occasionally escalated member interactions with professionalism and empathy.

Qualifications

• Minimum of 1 year of experience in healthcare, health insurance, managed care, banking, finance, law enforcement, investigations, compliance, customer service, or a related field.

• Experience managing a high-volume workload or caseload.

• Strong written and verbal communication skills.

• Excellent customer service, investigative, and problem-solving abilities.

• Strong organizational skills and attention to detail.

• Proficiency with Microsoft Office (Word, Excel, Outlook).

• Health plan or managed care experience is preferred.

• Experience with Everest is a plus.

Required Assessments

Candidates selected to move forward in the process will be required to complete:

• Workplace Reasoning Assessment (deductive reasoning and problem-solving)

• Writing Assessment (evaluates writing skills, comprehension, and professional communication)

Job Type & Location

This is a Contract position based out of Fairfield, CA.

Pay and Benefits

The pay range for this position is $36.00 - $36.00/hr.

Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

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. If eligible, the benefits available for this temporary role may include the following: Medical, dental & vision Critical Illness, Accident, and Hospital 401(k) Retirement Plan Pre-tax and Roth post-tax contributions available Life Insurance (Voluntary Life & AD&D for the employee and dependents) Short and long-term disability Health Spending Account (HSA) Transportation benefits Employee Assistance Program Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a hybrid position in Fairfield,CA.

Application Deadline

This position is anticipated to close on Oct 8, 2026.

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.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.