Program Assistant (Grievance & Appeals)

$48,880 - $68,640/Yr

Kinetic Personnel Group - Orange, CA

Full-time - Entry Level

Orange, CA

Administrative and Support Services

About the position

The Program Assistant for Grievance & Appeals will support the Grievance and Appeals Resolution Services (GARS) department within a Public Health Plan. This role involves monitoring and processing appeals and grievances, serving as a point of contact for inquiries, and assisting in administrative tasks related to the department's operations. The position is initially temporary with the potential for permanent placement after six months.

Responsibilities

• Monitor the GARS member and provider mailbox, fax, mail, and process appeals and grievances for assignment to key staff.
• Participate in a mission-driven culture focused on high-quality performance and member service.
• Serve as the point of contact for inquiries related to grievances and appeals.
• Monitor incoming complaints via various channels including Customer Service system, mail, telephone, and email.
• Respond to requests for information from the Department of Managed Health Care (DMHC) and other regulatory bodies in a timely manner.
• Set up complaint case files and enter cases in the GARS system with accurate classification and category types.
• Assist in the development of departmental forms and intake processes.
• Coordinate administrative support for state hearings and manage documentation related to incoming cases.

Requirements

• High School diploma or equivalent required.
• 1 year of experience in appeal and grievance guidelines or Medi-Cal/Medicaid or Medicare programs required.

Nice-to-haves

• Bilingual in English and one of the defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese).

Benefits

• 401(k)
• Dental insurance
• Health insurance
• Vision insurance