Case Coordinator

Immediate need for a talented Case Coordinator . This is a 06+ Months Contract opportunity with long-term potential and is located in Corona, CA(Onsite) .

Please review the job description below and contact me ASAP if you are interested.

Job ID : 24-43212

Pay Range : $15 - $20 / hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Requirements and Technology Experience :

• Skills- Appeals, Grievances & Healthcare background.
• 3+ years of experience in complaint and grievance process.
• Accountable for investigation of all issues, including collection and documentation of appropriate data.
• Identify and address specialty / flagged cases and follow appropriate processes for different types of cases.
• Communicate with a diverse set of internal and external clientele to achieve excellent results in the areas of complaint and grievance handling, compliance, documentation, and enhancement of the member experience.
• Partner with and outreach to internal staff, other MS Departments, managers, and physicians to resolve issues as quickly as possible.
• Research, resolve and communicate complaints and grievances filed by members and communicate Health Plan's decisions appropriately back to member or their authorized representatives.
• Ensure that complaints and grievances are processed in accordance with regulations, compliance standards, policies, and procedures.
• Meet timeframes for performance while balancing the need to produce high quality work related to complex and sensitive member issues.
• Ensure integrity of departmental database by thorough, timely and accurate entry, consistent with regulatory protocols and effectively manage case resolution inbox every day.
• Participate in departmental meetings, trainings and audits as requested.
• Answer questions and manage members on existing / open cases Escalate issues to management as appropriate to maintain compliance.
• Experience in a complex health care environment preferred.
• Strong working knowledge of federal and state regulations, laws and accreditation standards related to health care and managed care organizations.
• Knowledge of member complaint and grievance processing preferred.
• Competent working knowledge of client Health Plan benefits plan / contracts / systems strongly preferred.
• High School / Associate / Bachelor’s degree.

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions.

If you are interested in this position, please apply online for immediate consideration.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.