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Chapter Medicare Jobs in California (NOW HIRING)

HENRY MAYO NEWHALL MEMORIAL HOSPITAL

Your next great chapter starts here. Job Summary The RN Case Manager-Pre Access is responsible for ... Understanding of Medicare, Medi-Cal and other Third Party Payer regulations * Understanding of ...

Magnolia Post Acute Care

Director of Nursing

El Cajon, CA · On-site

$110K - $170K/yr

Working knowledge of Title XXII and OBRA, HCFA, Chapter 3, state and federal regulations pertaining to skilled nursing facilities, Medicare, Medi-Cal. * Ability to maintain confidentiality in a ...

All JobsChapter Medicare JobsChapter Medicare Jobs in California

Chapter Medicare information

What is the difference between Chapter Medicare vs Medicare Insurance Specialist?

AspectChapter MedicareMedicare Insurance Specialist
CertificationsMedicare-related certifications, such as CMS certificationsMedicare-related certifications, such as CMS certifications
Work EnvironmentHealthcare organizations, government agencies, or insurance companiesInsurance agencies, brokerages, or healthcare consulting firms
Employer & Industry UsageUsed by organizations managing Medicare plans and policiesUsed by professionals advising clients on Medicare options
Search & Comparison IntentUnderstanding Medicare plan options and regulationsAssisting clients with Medicare enrollment and coverage choices

While both roles involve Medicare, Chapter Medicare typically refers to the legal or regulatory framework within Medicare plans, whereas a Medicare Insurance Specialist focuses on advising and assisting individuals with Medicare coverage options. The specialist role is more client-facing, while Chapter Medicare relates to the broader program structure.

What are the key skills and qualifications needed to thrive as a Medicare insurance agent, and why are they important?

To thrive as a Medicare Insurance Agent, you need comprehensive knowledge of Medicare plans, strong sales acumen, and a state insurance license. Familiarity with customer relationship management (CRM) software, quoting tools, and Medicare enrollment platforms is typically required. Excellent communication, active listening, and the ability to explain complex information clearly are valuable soft skills. These abilities are crucial for guiding clients to suitable coverage options and ensuring compliance with regulatory requirements.

What is Chapter Medicare?

Chapter Medicare is a company that helps individuals navigate Medicare options and select the most suitable health insurance plans. Their licensed advisors provide personalized guidance, answering questions about coverage, costs, and enrollment. Chapter Medicare aims to simplify the often confusing Medicare process by offering unbiased support and helping clients maximize their benefits. They work with a wide range of insurance providers to ensure clients have access to the best possible coverage for their needs.

What are the main challenges Chapter Medicare advisors face when helping clients choose a Medicare plan?

Chapter Medicare advisors often navigate complex plan options and regulatory requirements to ensure clients select the best coverage for their unique health and financial needs. A common challenge is clearly explaining differences between Medicare Advantage, Supplement, and Prescription Drug Plans, while also accounting for changing healthcare needs and budgets. Advisors must stay updated on annual policy changes and build trust with clients through empathetic, clear communication. Collaborating with team members, such as compliance or technology specialists, is essential to provide accurate and timely guidance.

What are popular job titles related to Chapter Medicare jobs in California?

For Chapter Medicare jobs in California, the most frequently searched job titles are:

What job categories do people searching Chapter Medicare jobs in California look for?

The top searched job categories for Chapter Medicare jobs in California are:

What cities in California are hiring for Chapter Medicare jobs?

Cities in California with the most Chapter Medicare job openings:

Chapter Medicare jobs near you
Infographic showing various Chapter Medicare job openings in California as of August 2026, with employment types broken down into 20% As Needed, and 80% Full Time. Highlights an 100% In-person job distribution.

Grievance and Appeals Analyst

COMMUNITY HEALTH GROUP

Chula Vista, CA • On-site

$70K - $82K/yr

Full-time

Re-posted 6 days ago

Job description

POSITION SUMMARY
Supports the Appeals Manager in the gathering of information to resolve customer concerns presented as a grievance or appeal. Works closely with internal departments and providers' staff to obtain pertinent information in a timely manner and in compliance with regulatory requirements.
COMPLIANCE WITH REGULATIONS
Works closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal regulations including Centers for Medicare and Medicaid Services (CMS) and/or Medicare Part D, Department of Managed Health Care (DMHC) and Department of Health Care Services (DHCS).
RESPONSIBILITIES
  • Educates and assists members and their family members or authorized representatives of Medicare and Medi-Cal grievance and appeals rights.
  • Determines member eligibility and utilization history using QNXT's membership, claims, prior authorization, and case management, complaint tracking systems.
  • Prepares and mails resolution decision letters that meet Medi-Cal or Medicare (CMC) requirements for content and timeliness.
  • Determines additional levels of appeals that member is entitled to and processes them in accordance with Medi-Cal and Medicare standards and requirements for timeliness.
  • Analyzes data collected and coordinates with member's treating providers and pertinent departments to resolve member's grievance.
  • Collects, analyzes and interprets data collected and communicates results in person or in writing to Grievance and Appeals Manager.
  • Responsible for reviewing, classifying, researching, investigating and resolving member complaints (grievances and/or appeals).
  • Within established timeframes, communicates resolution to members or their authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid.
  • Adheres to CHG's Appeals and Grievances policies are based on Medicare Managed Care Manual Chapter 13 and Title 22, pertaining to the processing of Medicare grievances and appeals.
  • Responsible for addressing and forwarding quality of care complaints to quality management for resolution.
  • Responsible for documenting on a daily basis all cases in Innovare.
  • Participate in regular meetings to review case logs and other matters as assigned.
  • Responsible for compiling, preparing and reporting all compliance and grievance data monthly.
  • Responsible for formulating/implementing and executing all processes, requests, workflow or policies as requested by management in a courteous and efficient manner, including offering a proactive approach to suggestions and recommendations and working or cooperating with Appeals and Grievance Manager or management effectively.
  • Act as a liaison to all company departments as necessary.
  • Responsible for special assignments or projects as requested by management.

Education
  • Bachelor's Degree Required

Experience
  • Four years' experience either processing grievances within a managed care setting or in customer services within a Medi-Cal or Medicaid environment.
  • Full working knowledge of medical terminology, Medi-Cal and Medicare-covered benefits.
  • Knowledge of Medi-Cal and Medicare standards and requirements.
  • Excellent verbal and written communication skills.
  • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
  • Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
  • Ability to integrate and analyze information from several sources and problem solve towards a resolution within tight timeliness.
    Ability to interact with both internal and external customers along with strong organizational and time management skills.
  • Must be able to accomplish duties and assignments with minimal supervision.

Physical Requirements
  • Prolonged periods of sitting and frequent walking.
  • May be required to work evenings and weekends.
  • Position may at times require weekend overtime and or travel to attend seminars.

The above statements describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.
All qualified applicants will receive consideration for employment based on merit, without regard to race, color, religion, sex, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law.

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