Job Description
Job Description
Grievance & Appeals (G&A) Coordinator II
Location: Alameda, CA (Hybrid – mostly WFH with occasional onsite meetings)
Pay: $30-$35/hr, paid biweekly
Start: 09/29/2025 - 06/26/2026 (This is a W2 contract assignment with opportunity to convert to direct based on attendance, performance, and business needs)
MUST have experience in health services, health insurance, hospital, or similar setting
About the Role
We are seeking a Grievance & Appeals Coordinator II to join our team. In this role, you will review, investigate, and process non-complex grievances across multiple lines of business, while ensuring accuracy, compliance, and excellent member communication. You will work independently within a collaborative team environment and play a key part in ensuring quality service and regulatory compliance.
Key Responsibilities
- Address and respond to telephonic and written inquiries regarding member non-complex grievances.
- Investigate, research, review, and resolve grievances within regulated timeframes.
- Interpret and apply policies, clinical guidelines, contracts, and regulatory requirements.
- Communicate with members and providers throughout the grievance process.
- Draft clear, professional written correspondence that meets regulatory standards.
- Maintain accurate case documentation and database records.
- Prepare and coordinate grievance documentation for State Fair Hearings, IMRs, and appeals.
- Identify and escalate systemic issues impacting member care or service.
- Manage a caseload of at least 60 cases per month while meeting quality and compliance standards.
- Collaborate with internal departments to resolve member issues.
- Participate in special projects as assigned.
Qualifications
- High school diploma or equivalent (required). Associate’s or Bachelor’s degree (preferred).
- 2+ years of experience in health services, health insurance, hospital, or similar setting (required).
Skills & Abilities
- Knowledge of managed care and medical terminology.
- Strong customer service and healthcare coordination background.
- Excellent verbal and written communication skills.
- Ability to handle sensitive information with confidentiality and accuracy.
Corrin Misak, Staffing Manager II
A-Line Staffing Solutions
cmisak@alinestaffing.com