Grievance Resolution Specialist (Provider Resolution) Healthcare

#LPN2025

We are currently seeking a Temporary Grievance Resolution Specialist (Provider Resolution) to join our team and support our mission of delivering high-quality, member-focused healthcare services.

This position plays a key role in coordinating the Grievance and Appeals resolution process , responding to verbal and written inquiries from both members and providers related to eligibility, benefits, contract administration, claims, pharmacy, vision, and utilization management decisions.

Position Details :

Job Title : Temporary Grievance Resolution Specialist (Provider Resolution)

Department : GA Provider Disputes

PAY Range : $25 / HR - $30 / HR

Schedule : Monday Friday | 8 : 00 AM 5 : 00 PM

Location : Orange, CA 92868

Duration : Temporary Assignment for 6 months

Key Responsibilities Include :

Investigate and resolve provider grievances and appeals

Collaborate with internal teams (Customer Service, Provider Relations, Pharmacy, Medical Management)

Review contracts, DOFRs, and policies to assess case details

Draft provider / member resolution letters and document case outcomes

Maintain accurate records in CalOptima Health's systems

Ensure regulatory compliance and timely resolution

Minimum Qualifications :

High school diploma or equivalent

1+ year of experience in Medicare / Medi-Cal provider appeals and denials

Experience in Grievances and Appeals, Claims, Compliance, or related areas

Strong communication, organizational, and case management skills

Preferred Qualifications :

Associate degree in healthcare administration or related field

Bilingual in one of CalOptima's threshold languages (e.g., Spanish, Vietnamese, Korean)

Familiarity with provider dispute resolution and regulatory standards

If you're looking to make an impact in healthcare and bring resolution to complex provider issues in a dynamic and supportive environment, we'd love to hear from you.

Please let me know if you're interested, and I will be happy to provide additional information on how to apply.

Best regards,

Ayushi kaushik

Healthcare Recruiter

Direct : 510.660.6056

Email : ayushi@arohatechnologies.com

5000 Hopyard RD, Suite 415

Pleasanton, CA 94568

https : / / www.arohatechnologies.com