Grievance and Appeals Coordinator {168612}
Job Description
Job Description
Grievance and Appeals Coordinator
Location: Alameda, CA 94502
Start Date: April 27, 2026
Pay Rate: $35.00/hour
A-Line Staffing is now hiring a Grievance and Appeals Coordinator in Alameda, CA. This is a great opportunity for professionals with experience in managed care, health services, appeals, grievances, or healthcare customer service who are looking to join a team focused on compliance, quality, and member support.
Job Summary
The Grievance and Appeals Coordinator is responsible for reviewing, investigating, and resolving non-complex member grievance cases within required turnaround times. This role requires strong attention to detail, excellent written and verbal communication skills, and the ability to work independently while collaborating within a team environment.
This position plays an important role in ensuring members receive timely, accurate resolutions while maintaining compliance with regulatory and contractual standards.
Responsibilities
- Review, investigate, and process non-complex grievances for all lines of business
- Respond to telephonic and written inquiries from members, member representatives, and providers
- Accurately identify and categorize grievance issues
- Research and resolve cases within required turnaround times
- Gather and review supporting information from members, providers, and internal teams
- Interpret health plan benefits, policies, procedures, and applicable regulations
- Prepare and send written correspondence regarding case determinations
- Maintain complete, accurate, and organized case documentation in the electronic database
- Monitor cases continuously for quality, accuracy, and compliance
- Coordinate grievance-related activities with internal departments
- Support appeal-related processes including State Fair Hearing, MAXIMUS, Independent Medical Review, and DMHC processes
- Identify operational issues impacting member care or service expectations
- Communicate case status and potential risks to leadership as needed
- Perform ongoing data entry and assist with special projects as assigned
- Manage a caseload of at least 60 cases per month
Qualifications
- High school diploma or equivalent required
- Associate’s or bachelor’s degree preferred
- At least 1-2 years of experience in health services, managed care, hospital operations, or a similar healthcare setting
- Knowledge of managed care and medical terminology
- Experience in customer service, case coordination, or grievance/appeals support in a healthcare environment
- Strong organizational, research, and problem-solving skills
- Excellent written and verbal communication skills
- Ability to manage deadlines and meet strict compliance timeframes
Apply Now
If you are interested in this Grievance and Appeals Coordinator position in Alameda, CA, apply today or contact:
Austin Faris
A-Line Staffing Solutions
Phone: 586-419-5866