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Job Title: Grievances and Appeals Coordinator

Job Description

The Grievances and Appeals Coordinator analyzes and resolves verbal and written claims, authorizations, complaints, grievances, and appeals from members and providers in a regulated healthcare environment. This role ensures timely, accurate, and compliant resolution of cases, supports performance and quality programs, and contributes to continuous improvement in member and provider experience through strong communication, documentation, and analytical skills.

Responsibilities

• Analyze and resolve verbal and written claims, authorization appeals, complaints, grievances, and appeals from members and providers.
• Gather, analyze, and report data related to member and provider complaints, grievances, and appeals to support compliance and quality standards.
• Prepare clear, professional response letters addressing member and provider complaints, grievances, and appeals.
• Maintain accurate and organized files on individual appeals and grievances, ensuring proper documentation and record-keeping.
• Coordinate the Grievance and Appeals Committee as needed, including preparing materials, organizing case reviews, and tracking outcomes.
• Support pay-for-performance programs through data entry, tracking, organizing, and researching information related to performance metrics.
• Assist with HEDIS production functions, including data entry, outbound calls to provider offices, and claims research to support quality reporting.
• Manage high volumes of documents, including copying, faxing, and scanning incoming mail and case-related materials.
• Research complex cases and compliance-related issues, ensuring decisions align with regulatory requirements and internal policies.
• Collaborate proactively with management and cross-functional departments to resolve complex cases and improve processes.
• Communicate clearly and professionally with internal teams, members, and providers regarding case status, outcomes, and next steps.
• Meet or exceed established performance indicators, including accuracy, quality compliance, efficiency, productivity, and customer satisfaction.
• Complete case reviews and resolutions within required timelines while maintaining high quality standards and attention to detail.
• Contribute to continuous improvement initiatives by identifying trends, issues, and opportunities to enhance grievance and appeals handling.

Essential Skills

• High school diploma or equivalent required; associate degree preferred.
• 2+ years of experience in appeals & grievances, claims, managed care, healthcare administration, or customer service.
• Strong written and verbal communication skills.
• Excellent attention to detail and accuracy.
• Proficiency with digital tools, case management systems, and office software.
• Strong analytical, research, troubleshooting, and problem-solving abilities.
• Ability to manage high workloads and maintain organization in a fast-paced environment.
• Comfortable working remotely and collaborating with cross-functional teams.
• Commitment to quality, compliance, and maintaining high accuracy standards (97%+).

Additional Skills & Qualifications

• Associate’s degree in a related field is preferred.
• Experience working with complex cases or compliance-related tasks in healthcare, insurance, or other regulated environments.
• Knowledge of healthcare regulations, including health plan compliance and regulatory requirements, and familiarity with Medicare/Medicaid guidelines.
• Conflict resolution skills, with the ability to handle sensitive cases with professionalism, empathy, and discretion.
• Project coordination experience, including exposure to coordinating cross-functional projects or initiatives in a fast-paced environment.
• Strong letter-writing skills, with the ability to tailor responses to members and providers while maintaining a professional tone.
• Experience supporting pay-for-performance programs through data entry, tracking, and information research.
• Experience with HEDIS-related functions such as data entry, provider outreach, and claims research.
• Comfort working with performance metrics and quality indicators, including accuracy, timeliness, and customer satisfaction.
• Demonstrated reliability and commitment to longer-term roles, with an interest in potential conversion from contract to permanent employment.

Why Work Here?

You will join a mission-driven organization that values accuracy, integrity, and meaningful impact on member and provider experiences in healthcare. The environment emphasizes collaboration, clear communication, and professional growth, offering opportunities to deepen your expertise in regulated healthcare operations, compliance, and quality programs. You will work within a supportive team that prioritizes continuous improvement, respects work-life balance through structured schedules, and provides a stable setting where strong performance and dedication are recognized and rewarded.

Work Environment

This is a remote position based in California, with candidates expected to reside within reasonable proximity to designated hubs near Woodland Hills and Natomas for occasional on-site team meetings or company events. The standard schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m. Pacific Time, with a 30-minute lunch break. An initial 8-week training period is conducted in a classroom-style virtual setting, where cameras are required to be on and time off is not permitted during the training duration to ensure full engagement and successful onboarding. Overtime may be required, with advance notice, and there may be occasional Saturday or holiday work, typically communicated 3–4 weeks in advance. The role involves extensive use of computers, case management systems, and standard office technology for tasks such as data entry, document management, and virtual collaboration, in a structured, quality-focused, and performance-driven environment.

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

The pay range for this position is $23.00 - $23.00/hr.

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)

This is a fully remote position.

This position is anticipated to close on Jul 20, 2026.

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

We’re a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We’re a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We’re strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We’re building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.