Healthcare Case Manager

Pyramid Consulting Healthcare; California; Remote; USD 24,797,000 - 41,328,000; Full time

Benefits offered by this job

Health insurance

401(k) plan

Paid sick leave

Job summary

Pyramid Consulting, Inc. is seeking a Healthcare Case Manager for a 9-12 month contract located in California with remote work options. The role requires handling appeals and grievances with a strong focus on member satisfaction.

The ideal candidate has 5+ years in healthcare, customer service experience, and knowledge of health plan benefits. Work hours are 8:30–5:00, Monday through Friday, with overtime opportunities as needed.

Qualifications

• 5+ years in healthcare handling appeals and grievances.
• HS Diploma or GED required; Bachelor's degree preferred.
• M-F 8:30-5pm with overtime potential.
• Remote options with first 2 weeks in office.
• Experience with Health Plan benefits plans/systems preferred.

Responsibilities

• Handle member appeals and grievances.
• Provide timely communication with members and health plans.
• Maintain up-to-date knowledge of health plan benefits.

Skills

Healthcare experience

Customer service

Appeals & grievances

Education

HS Diploma

Bachelor's degree preferred

Job description

Immediate need for a talented Healthcare Case Manager. This is a 09-12+months contract opportunity with long-term potential and is located in CA(Remote).

Job ID:26-31273

Pay Range: $30/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Remote Options (Fully Remote, Partially Remote, Onsite): Telecommuter. First 2 weeks need to be in office. (might be only few day)

Key Requirements and Technology Experience:

• Min level of experience - 5 years in healthcare (handling appeals and grievances)
• Letter writes and customer service is important
• Education and Preferred Level of Education: HS Diploma but Bachelors is preferred
• M-F Normal business hours 8:30-5pm with opportunities for overtime.
• Member complaint and grievance processing preferred.
• Competent working knowledge of client Health Plan benefits plan/contracts/systems strongly preferred.
• Educational requirement - high school diploma or GED required. Some college preferred.

Our client is a leading Healthcare and Insurance Industry, and we are currently interviewing to fill this and other similar contract positions.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.