[Hiring] Health Plan Appeals & Grievances Coordinator @Pyramid Consulting

Role Description

Immediate need for a talented Health Plan Appeals & Grievances Coordinator (California). This is a 06+ Months Contract opportunity with long-term potential and is located in US (Remote).

We are seeking a detail-oriented Case Manager – Appeals & Grievances to:

• Investigate, coordinate, and resolve member complaints, grievances, and appeals in compliance with health plan and regulatory standards.
• Ensure timely and fair resolutions, accurate documentation, and strong cross-functional collaboration.

Qualifications

• 2+ years experience in Appeals, Grievances, Utilization Management, or Care Coordination in a health plan or TPA.
• Strong understanding of CMS, DMHC, and NCQA regulatory standards.
• 5+ years of Appeals & Grievances experience within a Health Plan or Managed Care organization.
• Excellent written communication skills.
• Experience reviewing medical records and clinical documentation.

Requirements

• Experience handling:
• Member Appeals
• Provider Appeals
• Claims Denials
• Authorization Appeals
• Benefit Determinations
• Knowledge of:
• CMS
• DMHC
• NCQA
• Medicare
• Medi-Cal
• Commercial Health Plans

Benefits

• Pay Range: $27 - $31/hour.
• Traveler benefits as per agency package. (Benefits vary by vendor and assignment.)

Company Description

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