Grievance and Appeals - Coordinator

What You Will Do:

• Coordinate, document, and track all member and provider grievances and appeals
• Ensure cases are processed in compliance with CMS, DHCS, DMHC, and internal guidelines
• Generate and distribute written correspondence to members, providers, and regulatory entities
• Maintain accurate records and ensure timely delivery of required notifications
• Assist staff with filing, tracking, and closing grievance and appeal cases
• Intake and triage new cases, assigning urgency and routing appropriately
• Communicate with members to gather information or provide case updates
• Act as a liaison across departments to ensure timely case resolution
• Monitor and report on open and pending cases to leadership
• Prepare summary reports and assist with process improvement initiatives
• Support departmental goals and contribute to continuous improvement efforts, including LEAN principles

You Will Be Successful If:

• You have a strong understanding of regulatory requirements and can ensure compliance
• You are highly organized and able to manage multiple cases and deadlines effectively
• You communicate clearly and professionally with members, providers, and internal teams
• You demonstrate sound judgment when escalating issues or identifying trends
• You are detail-oriented and ensure accuracy in documentation and correspondence
• You thrive in a fast-paced, team-oriented environment
• You maintain a strong customer service mindset when working with diverse populations

What You Will Bring:

• High school diploma or GED required
• 3+ years of administrative experience in an office setting
• Proficiency in Microsoft Word, Excel, and data entry
• Typing speed of at least 45 WPM
• Strong communication and interpersonal skills
• Excellent organizational skills and attention to detail
• Ability to multitask and meet deadlines in a high-volume environment
• Professional phone etiquette
• Ability to learn and follow established processes and procedures
• Team-oriented mindset with a positive attitude
• Cultural awareness and sensitivity to diverse populations
• Bilingual English/Spanish skills (if applicable to role)

About Impresiv Health:

Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.

Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do – provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.

That’s Impresiv!