Benefits:
401(k)
401(k) matching
Company parties
Dental insurance
Employee discounts
Free food & snacks
Health insurance
Opportunity for advancement
Paid time off
Parental leave
Savings bank
Training & development
Vision insurance
Wellness resources
About the Role:
MedPOINT Management in Sherman Oaks, CA is looking for a detail-oriented Grievance and Appeals Coordinator to join their dynamic healthcare team. In this critical role, you'll serve as a key advocate in ensuring member concerns are handled with care, compliance, and efficiency. If you're passionate about healthcare operations and making a real difference for patients, this is the opportunity for you.
Responsibilities:
Receive, document, and track member grievances and appeals in accordance with regulatory guidelines
Investigate and coordinate resolution of complaints, appeals, and grievances in a timely manner
Collaborate with clinical, provider relations, and compliance teams to facilitate case resolution
Ensure adherence to state and federal regulatory requirements, including DMHC and CMS guidelines
Prepare and distribute written correspondence and resolution letters to members and providers
Maintain accurate case records and generate reports on grievance and appeals activity and trends
Participate in quality improvement initiatives related to member satisfaction and complaint reduction
Requirements:
2+ years of experience in grievance and appeals, managed care, or health plan operations
Strong knowledge of DMHC, CMS, and NCQA regulatory requirements preferred
Excellent written and verbal communication skills with strong attention to detail
Proficiency in case management or healthcare information systems
Ability to manage multiple cases simultaneously and meet strict deadlines
Strong analytical and problem-solving skills with a member-first mindset
Associate's or Bachelor's degree in Healthcare Administration or a related field preferred
About Us:
MedPOINT Management is a leading Independent Physician Association (IPA) management company based in Sherman Oaks, CA, with decades of experience supporting healthcare providers across Southern California. Providers and members trust MedPOINT for their commitment to quality care coordination, operational excellence, and innovative managed care solutions. Employees thrive in a collaborative, mission-driven environment where their work directly impacts the health and well-being of the communities they serve.
Flexible work from home options available.