Temporary Grievance Coordinator at The Singing Machine Company

, California, United States -

Full Time

Start Date

Immediate

Expiry Date

03 Mar, 26

Salary

32.0

Posted On

03 Dec, 25

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Managed Healthcare, Healthcare Coverage, Benefit Structures, Coordination of Benefits, Medical Billings, Utilization Management, Grievance Regulations, Customer Service, Communication, Administrative Duties, Case Work, Training, Operational Improvement, Professional Correspondence, Computer Systems, Medi-Cal

Industry

Description

ABOUT THIS TEMP POSITION This is a temporary position and the length of the assignment is estimated to go from January 6, 2026 to June 30, 2026. The length of the assignment is always dependent on business need and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with. We have an opportunity to join the Alliance as a Grievance Coordinator in the Member Services Department. This position will require in office presence either in our Merced or Scotts Valley office (hybrid). WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Grievance Supervisor, this position: Assists in the administration and resolution of low complexity cases in support of the Alliance Grievance function Performs administrative duties to track, organize, monitor, and follow up on case work Participates in departmental and cross-departmental trainings, workgroups, and operational improvement activities Performs other duties as assigned ABOUT THE TEAM Grievance work involves complex coordination, investigation and specific resolution(s) within regulatory timeframes. Areas of Grievance work include: Appeals: A member complaint involving an adverse benefit determination by an Alliance Utilization Management (UM) decision. Member Grievances (Complaints): An oral or written statement submitted by a member or a member's authorized representative expressing dissatisfaction with any aspect of the Alliance's health care plan. Expedited Appeals/ Grievances: A complaint or Appeal involving an imminent and serious threat to the health of the member, as determined by an Alliance Medical Director that includes, but is not limited to, severe pain, potential loss of life, limb or major bodily function. State Fair Hearings: The process whereby a member enrolled in Medi-Cal requests the Department of Social Services (DSS) and its Administrative Law Division to resolve Plan decisions that deny, modify or delay health care services or affect Medi-Cal benefits. Inquiries: A question or request for information or assistance by a member that does not reflect the member's dissatisfaction with any aspect of the Alliance's health care plan. Complex Member Billing Issues or Member Reimbursements: When an Alliance member receives a bill from a medical provider for covered services or paid out of pocket for covered Medi-Cal services. WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description and list of requirements, click here. Knowledge of: Principles and practices of managed healthcare, healthcare Coverage and benefit structures, principles of coordination of benefits, and medical billings Title 22 and Title 28 utilization management and grievance regulations The diverse needs of the Medi-Cal population Customer service principles and practices Ability to: Understand and communicate the complex operations and processes of the Alliance, particularly the Utilization Management, Care Management, and Member Services departments Use the Alliance's internal tracking systems Draft professional correspondence Learn and utilize computer systems and verbally communicate the program's mission, vision, and roles Education and Experience: Associate's degree in health, social services or a related field and one year of experience in a managed health care setting, health plan, or provider office interacting with members, patients, or providers and receiving complaints, preferably related to healthcare administration or public assistance; or an equivalent combination of education and experience may be qualifying OTHER INFORMATION We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. This is a temporary position and does not provide the benefits that are listed below (this is standard language from our regular job posts and cannot be altered or removed). Temporary employees on assignment at the Alliance will be connected to a staffing agency with separate benefit options. The full compensation range for this position is listed by location below. The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location). Santa Cruz County Pay Range $24.61—$32 USD Merced County Pay Range $22.40—$29.12 USD OUR BENEFITS Medical, Dental and Vision Plans Ample Paid Time Off 12 Paid Holidays per year 401(a) Retirement Plan 457 Deferred Compensation Plan Robust Health and Wellness Program Onsite EV Charging Stations And many more ABOUT US We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer Join us at Central California Alliance for Health (the Alliance) is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. We currently serve more than 418,000 members. To learn more about us, take a look at our Fact Sheet. At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

Responsibilities

Assist in the administration and resolution of low complexity cases in support of the Alliance Grievance function. Perform administrative duties to track, organize, monitor, and follow up on case work.