Healthcare Claims Coordinator – Appeals & Grievances
Pyramid Consulting, Inc, Anaheim, CA, United States
Healthcare Claims Coordinator – Appeals & Grievances
06+ Months Contract
-
Location: Anaheim, CA (Onsite)
Job ID: 26-05632
Pay Range: $20 - $23/hour. Traveler benefits as per agency package. (Benefits vary by vendor and assignment.)
Key Responsibilities:
Manage full lifecycle of appeals and grievances (intake → investigation → determination → closure)
Review denied claims, benefit disputes, and quality of care concerns
Collaborate with RNs, Medical Directors, Utilization Management, and Compliance teams
Ensure all cases meet regulatory turnaround times (TAT)
Maintain accurate, audit‑ready documentation
Communicate with members and providers regarding case status and outcomes
Key Requirements and Technology Experience:
5+ years of experience in Appeals & Grievances / Utilization Management / Case Management
Strong experience with member appeals (NOT just billing or call center)
Strong knowledge of CMS, DMHC, NCQA guidelines
Proven experience writing appeal/determination letters
Ability to manage high-volume caseloads with strict deadlines
Experience with Medicare, Medi-Cal, and Commercial plans
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.
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06+ Months Contract
-
Location: Anaheim, CA (Onsite)
Job ID: 26-05632
Pay Range: $20 - $23/hour. Traveler benefits as per agency package. (Benefits vary by vendor and assignment.)
Key Responsibilities:
Manage full lifecycle of appeals and grievances (intake → investigation → determination → closure)
Review denied claims, benefit disputes, and quality of care concerns
Collaborate with RNs, Medical Directors, Utilization Management, and Compliance teams
Ensure all cases meet regulatory turnaround times (TAT)
Maintain accurate, audit‑ready documentation
Communicate with members and providers regarding case status and outcomes
Key Requirements and Technology Experience:
5+ years of experience in Appeals & Grievances / Utilization Management / Case Management
Strong experience with member appeals (NOT just billing or call center)
Strong knowledge of CMS, DMHC, NCQA guidelines
Proven experience writing appeal/determination letters
Ability to manage high-volume caseloads with strict deadlines
Experience with Medicare, Medi-Cal, and Commercial plans
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.
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