Location
Los Angeles
Job Type
Full-time
Posted
July 08, 2026
Job Description
Grievance & Appeals Representative
Location: Remote
Experience Level: Entry Level
Position Purpose
Analyze and resolve verbal and written claims and authorization appeals from providers, while pursuing resolution of formal grievances from members.
Key Responsibilities
+ Gather, analyze, and report verbal and written member/provider complaints, grievances, and appeals.
+ Prepare response letters for member and provider complaints, grievances, and appeals.
+ Maintain files on individual appeals and grievances.
+ Coordinate the Grievance and Appeals Committee as needed.
+ Support pay‑for‑performance programs through data entry, tracking, organizing, and research.
+ Assist with HEDIS production functions including data entry, provider outreach, and claims research.
+ Manage large volumes of documents including copying, faxing, and scanning incoming mail.
Education & Experience
+ High school dip...
Location: Remote
Experience Level: Entry Level
Position Purpose
Analyze and resolve verbal and written claims and authorization appeals from providers, while pursuing resolution of formal grievances from members.
Key Responsibilities
+ Gather, analyze, and report verbal and written member/provider complaints, grievances, and appeals.
+ Prepare response letters for member and provider complaints, grievances, and appeals.
+ Maintain files on individual appeals and grievances.
+ Coordinate the Grievance and Appeals Committee as needed.
+ Support pay‑for‑performance programs through data entry, tracking, organizing, and research.
+ Assist with HEDIS production functions including data entry, provider outreach, and claims research.
+ Manage large volumes of documents including copying, faxing, and scanning incoming mail.
Education & Experience
+ High school dip...
Ready to Apply?
Submit your application for Grievance & Appeals Coordinator I - 210056 at TEKsystems
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