Grievance & Appeals Case Analyst

TEKsystems; United States; Hybrid; USD 41,000 - 58,000; Full time

Job summary

Partnership HealthPlan of California is seeking a Grievance & Appeals Case Analyst to investigate, manage, and resolve member grievances and appeals in a fast-paced environment. This on-site role focuses on problem-solving and clear communication with members while handling a high-volume caseload.

The ideal candidate will have healthcare or managed care experience, strong written and verbal skills, and proficiency with Microsoft Office. Everest experience is a plus for handling escalations.

Qualifications

• Minimum of 1 year of experience in healthcare, health insurance, managed care, or related field.
• Experience managing a high-volume workload or caseload.
• Strong written and verbal communication skills.
• Proficiency with Microsoft Office (Word, Excel, Outlook).
• Health plan or managed care experience 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

Healthcare experience

Investigation

Communication skills

Microsoft Office

Tools

Everest

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 jobclassification 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 & visionCritical Illness, Accident, and Hospital401(k) Retirement Plan Pre-tax and Roth post-tax contributions availableLife Insurance (Voluntary Life & AD&D for the employee and dependents)Short and long-term disabilityHealth Spending Account (HSA)Transportation benefitsEmployee Assistance ProgramTime 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.

The company is an equal opportunity employer and will consider all applications without regard 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.