Johnson Service Group (JSG) is seeking a Grievance and Appeals Coordinator. This is a remote role but MUST Live in California. Work Schedule/ Hours: Monday-Friday 8:00am-5:00pm Pay rate: $29.00-35.00 DOE General Description Implement Company Grievance and Appeals processes by resolving complaints filed by Company members and their representatives as well as provide back-up support to Member Services and CareAdvantage units. Duties & Responsibilities Essential Functions: Research and resolve member complaints for all lines of business ensuring compliance with Company Grievance and Appeals policies and procedures. Maintain grievance and appeals case files in Company database. Effectively communicate with members and providers verbally and in writing. Prepare summaries and write resolution letters for members, which include summarizing member complaints and steps taken to resolve complaints in clear and grammatically correct language. Attend and present cases at bi-weekly Staff Grievance and Appeals Committee. Prepare files for appeals to regulatory agencies. Maintain current on all regulatory requirements as they apply to grievance and appeal processes. May, as needed, provide necessary coverage in the call centers for Member Services and CareAdvantage. Secondary Functions: Perform other duties as assigned. Qualifications The following represents the typical way to achieve the necessary skills, knowledge and ability to qualify for this position: Education and experience equivalent to: Associate’s degree in health, business, social sciences, or humanities, preferred. Two (2) years of experience working with Medi-Cal or Medicare in a managed care environment preferred. Work performing grievance and appeals processing preferred. Work in a call center, claims department, and/or other customer service position required. JSG offers medical, dental, vision, life insurance options, short-term disability, 401(k), weekly pay, and more. Johnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law. #D800
