Grievance & Appeals Coordinator II — Compliance

Alameda Alliance; Alameda (CA); Hybrid; USD 63,000 - 94,000; Full time

Job summary

Alameda Alliance in California is seeking a Grievance and Appeals Coordinator II to review, investigate, and process non-complex grievances for all lines of business. You will ensure timely, accurate written communications and maintain complete records in the electronic database while working independently within a team.

The role requires knowledge of managed care, medical terminology, and excellent verbal and written communication skills, with 1–2 years in health services and a willingness to

Qualifications

• Hs diploma or equivalent, required.
• Associates and/or bachelor's degree, preferred.
• Minimum of one to two years of experience in health services, managed care, hospital, or similar setting, required.
• Knowledge of managed care and medical terminology.
• Experience in a customer service or coordination in a healthcare setting or equivalent experience.
• Excellent verbal and written communication skills.
• Proficient in Microsoft Word, Excel, Access, Outlook, and PowerPoint.

Responsibilities

• Review, investigate and process non-complex grievances for all lines of business.
• Respond to inquiries and communicate disposition to members, representatives, or providers.
• Investigate, research, and resolve grievances within regulatory timeframes.
• Interpret contracts, policies and regulatory requirements.
• Coordinate with other departments to resolve grievance issues.
• Maintain accurate grievance records in the electronic database.
• Prepare written correspondence to members, representatives or providers.

Skills

Managed care knowledge

Healthcare customer service

Verbal and written communication

Organizational skills

Team player

Education

HS diploma or equivalent

Associates and/or bachelor's degree

Tools

MS Word

Excel

Access

Outlook

PowerPoint

Job description

Alameda Alliance in California is seeking a Grievance and Appeals Coordinator II to review, investigate, and process non-complex grievances for all lines of business. You will ensure timely, accurate written communications and maintain complete records in the electronic database while working independently within a team.

The role requires knowledge of managed care, medical terminology, and excellent verbal and written communication skills, with 1–2 years in health services and a willingness to