Program Assistant, Grievance & Appeals

CalOptima Foundation

Orange, CA, US
Pyy grade: 302 - $49,754 - $69,655 ($23.92 - $33.4...
On-site
Monitor member and provider mailbox
Process appeals and grievances
Respond to regulatory agency inquiries
The Program Assistant will be an integral part of the Grievance & Appeals team, helping to strive for excellence while serving member health with dignity

Job Summary

  • The Program Assistant will be an integral part of the Grievance & Appeals team, helping to strive for excellence while serving member health with dignity.
  • Responsibilities include monitoring incoming complaints, processing appeals and grievances, and responding to inquiries from regulatory agencies.
  • CalOptima Health offers competitive compensation, a comprehensive benefits package including a CalPERS pension, generous PTO, and opportunities for professional development.

Matching Summary

The Program Assistant will be an integral part of the Grievance & Appeals team, helping to strive for excellence while serving member health with dignity.

Salary

Pay Grade: 302 - $49,754 - $69,655 ($23.92 - $33.4880); Bonus/Equity: Not specified; Benefits: Comprehensive benefits package

Skills & Requirements

Must-have

  • Monitor member and provider mailbox
  • Process appeals and grievances
  • Respond to regulatory agency inquiries
  • Set up complaint case files
  • Enter cases in GARS system
  • Generate acknowledgment letters

Nice-to-have

  • Mission-driven culture
  • Member focus on customer service
  • Collaborate with internal and external departments
  • Bilingual in threshold languages

Key Requirements

  • 1 year experience in appeal and grievance guidelines
  • Medi-Cal/Medicaid or Medicare programs experience
  • High school diploma or equivalent

Work Rights

Not specified

Tailored Resume

Cover Letter