Grievance and Appeals Resolution Specialist

Irvine, CA 92614

Employment Type: Temp-to-Hire Category: Healthcare Job Number: [SA] Medical Insurace, Grievance, Appeals, Pay Rate: $15.00

Resolution Specialist

  • Research and generate written responses to patient and provider correspondence pertaining to eligibility, claims, refund requests, returned mail, and all general inquiries.


  • Prepare and present appeal cases to the Administrative Review Committee and grievances to the Client Relations Review Committee.


  • They formulate survey results, submit non elective requests for medical review, and maintain production logs.


  • Maintains Excel production logs with accurate dates and data, and updates them daily.


  • Generates acknowledgement letters within 5 calendar days of receipt for all Appeals and Grievances – Timing is critical



  • High school diploma or equivalent (GED) required
  • Secondary school: Preferred certification from a course in Medical Billing & Coding
  • Minimum two years of: Grievance and Appeals / Medical Claims
  • Performs miscellaneous job-related duties as assigned - Must be a team player
  • Excellent organization and time management skills and flexibility to handle changing priorities
  • Computer savvy: Microsoft Word and Microsoft Excel
  • Type minimum of 45 WPM 100% accuracy



This position is temp-to-hire, which pays $15.00 hourly during the temporary assignment with a potential increase to $16.00 upon hire with an excellent benefits package, positive work environment, employee appreciation events - we like to have fun and share the happiness!


We will consider for employment all qualified Applicants, including those with Criminal Histories, in a manner consistent with the requirements of applicable state and local laws, including the California Fair Employment and Housing Act (FEHA).


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