[Hiring] Grievance & Appeals Coordinator I @TEKsystems

Role Description

Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.

• Gather, analyze and report verbal and written member and provider complaints, grievances and appeals
• Prepare response letters for member and provider complaints, grievances and appeals
• Maintain files on individual appeals and grievances
• May coordinate the Grievance and Appeals Committee
• Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information
• Assist with HEDIS production functions including data entry, calls to provider’s offices, and claims research
• Manage large volumes of documents including copying, faxing and scanning incoming mail

Qualifications

• High school diploma or equivalent
• Associate’s degree preferred
• 2+ years grievance or appeals, claims or related managed care experience
• Strong oral, written, and problem-solving skills

Requirements

• 2-3 years of experience in a similar role, preferably within appeals and grievances, healthcare administration, or customer service in a regulated environment
• Researching skills
• Experience working with complex cases or compliance-related tasks is highly desirable

Nice to haves

• Knowledge of Healthcare Regulations – Understanding of health plan compliance, regulatory requirements, or experience with Medicare/Medicaid guidelines
• Conflict Resolution Skills – Ability to handle sensitive cases with professionalism and empathy
• Project Coordination Experience – Exposure to coordinating cross-functional projects or initiatives in a fast-paced environment
• Good Letter writing skills

Disqualifiers

• Job hopping – Please state if the previous position was contract and if completed. Looking for individuals to move forward with conversion and serious about the role
• Lack of Experience in Appeals/Grievances or Regulated Environments – Candidates without relevant experience in healthcare, insurance, or similar regulatory fields may not be suitable
• Poor Attention to Detail – Inaccuracies or errors in case handling can impact quality standards
• Inadequate Communication Skills – The role requires clear and effective communication with team members and stakeholders

Experience Level

Entry Level

Job Type & Location

This is a Contract position based out of Los Angeles, CA.

Pay and Benefits

The pay range for this position is $23.00 - $23.00/hr. Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully remote position.

Application Deadline

This position is anticipated to close on Sep 11, 2026.