Appeals and Grievances
Job Description
Job Summary
We are seeking an Appeals and Grievances professional for a contract opportunity in Martinez, CA within the healthcare services industry. This role is ideal for a detail-oriented administrative and claims processing professional with experience supporting managed care appeals, grievances, hearings, regulatory reviews, and reporting requirements.
In this position, you will support an important healthcare operations function focused on compliance, member concerns, documentation accuracy, and regulatory readiness. The team environment is collaborative, mission-driven, and focused on quality, accountability, and service. This is a strong opportunity to contribute to meaningful work while partnering with compliance, operations, and leadership teams in a structured healthcare setting.
Key Responsibilities
- Support Appeals and Grievance Department activities in alignment with California managed care contract requirements.
- Assist with grievance, appeal, and hearing documentation, tracking, reporting, and case follow-up.
- Support regulatory audits, focused reviews, and readiness activities related to grievances and hearings.
- Review and apply DHCS All Plan Letters, Federal Medicaid managed care regulations, and internal compliance requirements.
- Prepare reports, metrics, and trend analyses for internal leadership, Compliance Committee review, and regulatory submissions.
- Maintain accurate records and support timely, compliant resolution of appeals and grievance-related matters.
Compensation and Benefits
- Pay range: $25.00 to $28.00 per hour.
- Job type: Contract/Temporary.
- Location: Martinez, CA.
Equal Opportunity Employer / Disabled / Protected Veterans
The Know Your Rights poster is available here:
https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf
The pay transparency policy is available here:
https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf
For temporary assignments lasting 13 weeks or longer, the Company is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.
We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.
AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.
https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf
We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
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