Grievance & Appeals Coordinator — Healthcare Quality

AlohaCare; Honolulu (HI); On-site; USD 23,000 - 29,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

401k with employer contribution

Paid time off

Referral bonus

Transportation & parking pre-tax

Job summary

AlohaCare in Hawaii is seeking a Grievance Coordinator to join the Appeals and Grievance team. You will ensure compliant, timely resolution of grievances and appeals, maintain logs, and produce required reports for QUEST Integration and CMS.

The role emphasizes customer service, accurate documentation, confidentiality, and collaboration with cross-functional teams under NCQA standards.

Qualifications

• Associates degree or equivalent combination of education and experience.
• Bachelor’s degree preferred.
• Experience with Grievance/Appeals processing or Medicaid/Medicare knowledge is preferred.
• Able to work in a fast-paced, matrixed environment and manage multiple projects.
• Strong time management, customer focus, and communication skills.

Responsibilities

• Review, research, and direct grievances and appeals to appropriate staff and track resolution.
• Maintain grievance and appeal logs and ensure timely disposition.
• Maintain electronic files and ensure accurate, policy-compliant communications.
• Prepare summaries for committee reviews and document decisions.
• Produce Grievance & Appeals reports for regulatory agencies.
• Participate in internal committee meetings and identify trends for improvement.
• Protect confidential information according to policy and law.

Skills

Interpersonal skills

Facilitation

Communication

Time management

Organizational skills

Independent work

Education

Associates degree

Bachelor’s degree

Job description

AlohaCare in Hawaii is seeking a Grievance Coordinator to join the Appeals and Grievance team. You will ensure compliant, timely resolution of grievances and appeals, maintain logs, and produce required reports for QUEST Integration and CMS.

The role emphasizes customer service, accurate documentation, confidentiality, and collaboration with cross-functional teams under NCQA standards.