Grievance & Appeals Specialist — Healthcare Programs

BuzzClan; Orange (CA); On-site; USD 42,000 - 62,000; Full time

Job summary

BuzzClan is seeking a detail-oriented Grievance & Appeals Specialist to manage intake, case documentation, and administrative support while ensuring compliance with healthcare program guidelines. You will receive, review, track, and route grievances and appeals, maintain accurate files, and coordinate with providers to gather supporting documents.

The role demands strong communication and the ability to handle confidential information.

Qualifications

• High School Diploma or equivalent.
• At least 1 year of experience with grievance and appeal guidelines, Medi-Cal/Medicaid, or Medicare programs.
• Proficiency in Microsoft Office, including Word, Excel, Outlook, and PowerPoint.
• Strong communication, organizational, and problem-solving skills.
• Ability to manage multiple tasks, meet deadlines, and handle confidential information.

Responsibilities

• Receive, review, track, and route grievances, appeals, and complaints.
• Maintain accurate case files and update information in designated systems.
• Gather supporting documents and coordinate with internal teams and providers.
• Prepare acknowledgment letters and required correspondence.
• Support regulatory requests and state hearing documentation.
• Ensure timely processing and maintain confidential records.

Skills

Attention to detail

Communication

Multitasking

Grievance & Appeals knowledge

Education

High School Diploma or equivalent

Tools

Microsoft Office

Excel

Word

Outlook

PowerPoint

Job description

BuzzClan is seeking a detail-oriented Grievance & Appeals Specialist to manage intake, case documentation, and administrative support while ensuring compliance with healthcare program guidelines. You will receive, review, track, and route grievances and appeals, maintain accurate files, and coordinate with providers to gather supporting documents.

The role demands strong communication and the ability to handle confidential information.