Remote Appeals & Grievances Case Manager – Health Plan (CA)

Pyramid Consulting, Inc; Los Angeles (CA); Remote; USD 37,000 - 43,000; Full time

Benefits offered by this job

Traveler benefits

Job summary

Pyramid Consulting, Inc. is seeking an Appeals & Grievances Case Manager for a California-based contract role in Los Angeles, with remote work options.

The position targets candidates with extensive appeals experience in health plans, including member and provider appeals, authorization appeals, and benefit determinations. Ideal applicants will have a solid grasp of CMS, DMHC, and NCQA standards, plus proven ability to review medical records and clinical documentation.

Qualifications

• 5+ years of Appeals & Grievances experience within a Health Plan or Managed Care organization.
• Experience handling: Member Appeals, Provider Appeals, Authorization Appeals, Benefit Determinations.
• Strong understanding of CMS, DMHC, and NCQA regulatory standards.
• Experience reviewing medical records and clinical documentation.

Skills

Appeals experience

CMS knowledge

Regulatory standards

Medical records review

Health plan experience

Job description

Pyramid Consulting, Inc. is seeking an Appeals & Grievances Case Manager for a California-based contract role in Los Angeles, with remote work options.

The position targets candidates with extensive appeals experience in health plans, including member and provider appeals, authorization appeals, and benefit determinations. Ideal applicants will have a solid grasp of CMS, DMHC, and NCQA standards, plus proven ability to review medical records and clinical documentation.