Job Description

HIRING NOW 100% REMOTE OPPORTUNITY : GRIEVANCE & APPEALS COORDINATOR

Member Services Department | 100% Remote Opportunity

Location Requirement: This is a 100% remote position; however, candidates must currently reside in Ventura, Santa Barbara, San Luis Obispo, Monterey, or Santa Cruz County to be considered.

About the Role

Are you experienced in healthcare, managed care, claims research, member advocacy, or grievance and appeals processes? We are seeking a detail-oriented Grievance & Appeals Coordinator to support the investigation, research, resolution, and documentation of member grievances, appeals, and billing-related issues.

This role is critical to ensuring members receive timely resolutions while maintaining compliance with regulatory, contractual, and health plan requirements. The ideal candidate will possess strong analytical, investigative, written communication, and customer service skills, along with a solid understanding of healthcare benefits, Medi-Cal, claims processing, and managed care operations.

Key Responsibilities

• Manage an assigned caseload of member grievances, appeals, and billing-related cases.
• Review and evaluate grievance documentation to ensure accurate categorization and processing.
• Contact members when additional information is needed to facilitate case resolution.
• Conduct detailed investigations and research to support grievance and appeal determinations.
• Prepare clinical grievance and appeal packets for review by Quality Improvement Nurses and Medical Directors.
• Resolve non-clinical grievance and appeal cases and prepare findings for management review.
• Draft and issue member correspondence and final determination letters within mandated timeframes.
• Ensure compliance with health plan policies, state and federal regulations, and contractual requirements.
• Research and resolve complex member billing concerns, benefit issues, retroactive cases, and state referrals.
• Provide feedback and guidance to Member Services teams regarding documentation standards and grievance processes.
• Collaborate with internal departments, provider offices, hospitals, government agencies, and community-based organizations.
• Provide investigative support related to State Fair Hearings and other escalated member concerns.
• Maintain accurate case documentation and ensure regulatory turnaround times are met.

Qualifications

Required

• Experience in managed care, health plan operations, member services, claims, grievances, appeals, or healthcare administration.
• Strong knowledge of healthcare benefits, eligibility, coordination of benefits, and billing processes.
• Excellent research, investigative, analytical, and problem-solving skills.
• Exceptional written and verbal communication skills.
• Ability to manage multiple priorities and maintain a high-volume caseload.
• Strong attention to detail and organizational skills.
• Ability to work independently with minimal supervision.
• Proficiency with Microsoft Windows and database systems.

Preferred

• Experience with Medi-Cal programs and regulations.
• Knowledge of pharmacy formularies and provider network requirements.
• Familiarity with hospital, physician, and provider office processes.
• Experience requesting and reviewing medical records.
• Bilingual Spanish skills are highly desirable.
• Experience with grievances, appeals, quality-of-care concerns, or billing investigations.

Top Skills

• Managed Care
• Medi-Cal
• Grievances & Appeals
• Member Services
• Health Plan Operations
• Benefits Investigation
• Billing Research
• Regulatory Compliance
• Medical Records Review
• Claims & Eligibility Research
• Customer Service
• Case Management
• Healthcare Administration
• Written Communication
• Problem Solving

Why Apply?

Join a mission-driven organization dedicated to helping members navigate complex healthcare issues and ensuring they receive fair, timely, and accurate resolutions. This role offers the opportunity to make a direct impact on member experience while working alongside a collaborative healthcare team.

100% Remote | Managed Care Experience Preferred | Healthcare Member Services | Hiring Now!

Job Type & Location

This is a Contract position based out of Santa Barbara, CA.

Pay and Benefits

The pay range for this position is $30.51 - $32.61/hr.

Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: Medical, dental & vision Critical Illness, Accident, and Hospital 401(k) Retirement Plan Pre-tax and Roth post-tax contributions available Life Insurance (Voluntary Life & AD&D for the employee and dependents) Short and long-term disability Health Spending Account (HSA) Transportation benefits Employee Assistance Program Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully remote position.

Application Deadline

This position is anticipated to close on Oct 16, 2026.

About TEKsystems

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

About TEKsystems and TEKsystems Global Services

Were a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. Were a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. Were strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. Were building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.