Appeals & Grievance Coordinator

Alignment Health

. Track and trend all grievances, appeals, and complaints received within the Member Services Department .

Posted 10/6/2026full-timeRemote • United StatesMid-LevelSenior💰 $44,790 - $67,185 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in managing grievances and appeals within Member Services, ensuring compliance with CMS guidelines and effective communication with diverse stakeholders. Proficient in data entry, documentation, and report preparation to support organizational processes.

Highest-signal resume keywords

Grievance And Appeal ManagementCMS Guidelines ComplianceEffective Written And Oral CommunicationCustomer Service ExperienceData Entry Skills

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Data EntryGrievance TrackingReport PreparationCase File Management10-Key By TouchTyping 40+ Words Per MinuteBasic Arithmetic SkillsDocumenting InvestigationsPolicy And Procedure ReviewMediCal And Medicare Knowledge

Soft Skills

Effective Problem-SolvingOrganizational SkillsTime-Management SkillsRelationship BuildingCommunication Skills

Certifications & Qualifications

High School DiplomaGED

Industry Keywords

Member ServicesCustomer ServiceGrievancesAppealsCTM ComplaintsRegulatory ComplianceAudit PreparationCommittee MeetingsTraining OpportunitiesProcess Improvements

About the role

Key responsibilities & impact

Track and trend all grievances, appeals, and complaints received within the Member Services Department
Act as the primary investigator and contact person for member and provider grievances and appeals
Acknowledge receipt of grievances, appeals, and CTM complaints
Gather relevant information and determine appropriate resolutions according to policies and procedures
Notify appropriate parties of resolutions and ensure internal processes are completed
Compose written correspondence to members according to plan policy and CMS Guidelines
Conduct unbiased, accurate, timely, and comprehensive investigations
Document all actions taken to resolve grievances and appeals
Ensure processing adheres to CMS guidelines and plan policy
Prepare case files for Medical Director and external reviews, including IRE review
Prepare case histories for committee and Board of Directors meetings
Maintain complete and timely grievance and appeal documentation
Prepare monthly and quarterly reports
Identify training opportunities and system or process improvements
Participate in policy and procedure reviews, CMS audit preparations, and regulator meetings/interviews
Perform other duties as assigned

Requirements

What you’ll need

Two years’ experience in data entry and general office background
Three years of customer service experience
Minimum 1 year Member Services or similar experience
High School Diploma or GED
Knowledge of MediCal and Medicare Managed Care Plans
Ability to keyboard/type 40+ words per minute
Ability to use the 10-key by touch
Effective written and oral communication skills
Ability to establish and maintain constructive relationships with diverse members, management, employees and vendors
Ability to read and interpret safety rules, operating and maintenance instructions and procedure manuals
Ability to write routine reports and correspondence
Ability to speak effectively before groups of customers or employees
Ability to perform basic arithmetic using American money and weight, volume and distance measurements
Effective problem-solving, organizational and time-management skills
Ability to work in a fast-paced environment
Must be available to work weekends

Benefits

Comp & perks

Fully remote work
Opportunity for growth and innovation
Reasonable accommodations for individuals with disabilities
Equal opportunity employment