Appeals & Grievances Coordinator

Appeals & Grievances Coordinator I – Med Impact curto Jr. Healthcare Systems, Inc.

The Appeals and Grievances (A&G) team is responsible for managing all aspects of the appeals and grievances process, including intake, processing, notification, and compliance. The Coordinator I serves as a key member of the team, processing requests in accordance with established standards for accuracy, timeliness, productivity, client performance commitments, and regulatory requirements (e.g., state and federal laws, professional accreditations). The position reports directly to the Supervisor of Appeals and Grievances Operations and is led by the Lead Coordinator (Coordinator III).

The Coordinator I uses various business applications—such as Med Access, Med Response®, File Net, and Right Fax—to perform analysis, retrieve information, and enter data as needed to complete assigned tasks. Strong reasoning skills are essential for evaluating requests and ensuring adherence to required processes. The ability to multitask and cross‑train in both appeals and grievances processing is essential to support the weekend rotation schedule.

• Evaluate and process appeals and grievances per established work instructions and approved departmental documents.
• Perform and document outreach activities (including outbound calls and faxes) to obtain information necessary for processing or to communicate results.
• Ensure cases are finalized within the required turnaround time (TAT) in accordance with applicable laws and company莫 policies.
• Cross‑train across the appeal and grievance task divisions.
• Participate in the rotating weekend on‑call schedule as needed.
• Protect and maintain confidentiality and privacy of all members’ personal and health information per federal requirements and company policies.
• Comply with company and department policies, procedures, rules and regulations.
• Adapt to departmental changes as required and remain flexible with shift changes.

• GED/HS Diploma and 1+ year of experience or an equivalent combination of education and experience.
• Proficiency with Microsoft Office (Word and Excel).
• Certified Pharmacy Technician or state licensure as a Pharmacy Technician required; preferred if certified.

• Oral Communication – speak clearly and persuasively; listen and clarify as needed.
• Written Communication – write clearly, edit for spelling and grammar.
• Teamwork – balance team and individual responsibilities; support a positive team spirit.
• Organizational Support – follow policies and procedures; complete tasks on time.
• Reasoning Ability – apply common sense; define problems, gather data, and draw valid conclusions പറ.
• Mathematical Skills – perform calculations and interpret simple graphs.
• Language Skills – read simple instructions; present information to customers and staff.

• Composure
• Decision Quality
• Organizational Agility
• Problem Solving
• Customer Focus
• Drive for Results
• Peer Relations
• Time Management
• Dealing with Ambiguity
• Learning on the Fly
• Political Savvy

The employee must be able to sit, greve, talk, stand, walk, use hands to reach and lift up to 25 lb.

Regular office environment with computers and printing equipment; noise level usually moderate.

On‑site at the San Diego Headquarters or other company location (remote location allowed with management approval).

Full‑time, non‑exempt. Overtime, nights, weekends, and holidays may be required as needed.

No travel is required; occasional attendance at local conferences and meetings may be necessary.

• Medical / Dental / Vision / Wellness Programs
• Paid Time Off / Company Paid Holidays
• Incentive Compensation
• 401(k) with company match
• Life and Disability Insurance
• Tuition Reimbursement
• Employee Referral Bonus

To explore all that Med Impact has to offer, please submit your resume to .

Equal Opportunity Employer, Male/Female/Disabilities/Veterans.