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Appeals & Grievances Specialist

Hybrid in Corona, CA, US • Posted 10 hours ago • Updated 10 hours ago

Contract W2

Hybrid

Depends on Experience

Fitment

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Job Details

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Summary

A client of Innova Solutions is immediately hiring for an Appeals & Grievances Specialist

Position type: Full-time, Contract
Duration: 12 + Months
Location: Corona, CA 92879 (Hybrid)

As an Appeals & Grievances Specialist, you will:

We are seeking a detail-oriented and customer-focused Case Manager to support the complaint and grievance process within a healthcare environment. This role involves investigating member concerns, ensuring regulatory compliance, and delivering timely and effective resolutions while maintaining a high standard of service and documentation.

You’ll have to visit the Corona location just to pick up your equipment and to take care of the IT issues.

Key Responsibilities

Manage and process member complaints and grievances in compliance with regulatory guidelines
Conduct thorough investigations, including data collection, documentation, and case analysis
Identify and handle complex or escalated cases, ensuring proper routing and resolution
Communicate effectively with members, internal teams, and external stakeholders
Collaborate with departments, managers, and physicians to resolve issues promptly
Maintain accurate and timely documentation in departmental databases
Ensure adherence to compliance standards, policies, and performance timelines
Monitor and manage case resolution inbox daily
Provide updates and responses to members or their authorized representatives
Participate in audits, training sessions, and team meetings
Escalate issues appropriately to ensure compliance and resolution

Requirements

High School Diploma or GED (required); some college preferred
Minimum 2 years of experience in a service-related or call center environment
Strong verbal and written communication skills
Excellent interpersonal and conflict resolution abilities
Ability to prioritize tasks and manage time effectively in a fast-paced environment
Strong problem-solving skills with sound judgment
Ability to handle sensitive and complex cases independently
Proficiency in Microsoft Office (Word, Outlook, Teams)
Typing speed of 50 WPM
Ability to multitask and work on both short- and long-term projects

The ideal candidate will have: 2+ years of experience in appeals and grievance handling within a healthcare or call center environment, along with strong communication, conflict resolution, and compliance management skills.

Qualified candidates should APPLY NOW for immediate consideration!
This position is only open to applicants who can be engaged on a W-2 basis.
Please hit APPLY to provide the required information, and we will be back in touch as soon as possible.
We are currently interviewing to fill this and other similar positions. If this role is not a fit for you, we do offer a referral bonus program for referrals that we successfully place with our clients, subject to program guidelines. ASK ME HOW.
Thank you!

Saurav Kumar
+1

PAY RANGE AND BENEFITS:
Pay Range*: $25 - $32 per hour
*Pay range offered to a successful candidate will be based on several factors, including the candidate''s education, work experience, work location, specific job duties, certifications, etc.

Benefits: Innova Solutions offers benefits( based on eligibility) that include the following: Medical & pharmacy coverage, Dental/vision insurance, 401(k), Health saving account (HSA) and Flexible spending account (FSA), Life Insurance, Pet Insurance, Short term and Long term Disability, Accident & Critical illness coverage, Pre-paid legal & ID theft protection, Sick time, and other types of paid leaves (as required by law), Employee Assistance Program (EAP).

ABOUT INNOVA SOLUTIONS: Founded in 1998 and headquartered in Atlanta, Georgia, Innova Solutions employs approximately 50,000 professionals worldwide and reports an annual revenue approaching $3 Billion. Through our global delivery centers across North America, Asia, and Europe, we deliver strategic technology and business transformation solutions to our clients, enabling them to operate as leaders within their fields.

Recent Recognitions:

Named One of America’s Best Employers for New Grads by Forbes (2024
Named One of the Best Companies to Work for by U.S. News & World Report (Private Companies List, 2024-2025)
One of the Largest IT Staffing Firms in the US – Ranked #3 by Staffing Industry Analysts (SIA, 2024)
One of the Largest Staffing Firms in the US – Ranked #13 by Staffing Industry Analysts (SIA, 2024; includes Innova Solutions, Volt, & HireGenics)
Named One of the Top Ten Private Companies in Atlanta by the Atlanta Business Chronicle (2023)
One of the Largest Certified Minority Business Enterprises (MBEs) in the United States (NMSDC, 2024)
AWS Advanced Tier Services Partner with 100+ certifications

Website:

Innova Solutions offers a referral bonus for qualified Ambassadors who refer eligible referrals. Submit referrals at and earn $250-$1,000 per referral.
Innova Solutions is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment. Innova Solutions is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment on the basis of race, color, religion or belief, national origin, citizenship, social or ethnic origin, sex, age, physical or mental disability, veteran status, marital status, domestic partner status, sexual orientation, or any other status protected by the statutes, rules, and regulations in the locations where it operates. If you are an individual with a disability and need a reasonable accommodation to assist with your job search or application for employment, please contact us at or . Please indicate the specifics of the assistance needed. Innova Solutions encourages all interested and qualified candidates to apply for employment opportunities. Innova Solutions (HireGenics/Volt) does not discriminate against applicants based on citizenship status, immigration status, or national origin, in accordance with 8 U.S.C. § 1324b.
The company will consider for employment qualified applicants with arrest and conviction records in a manner that complies with the San Francisco Fair Chance Ordinance, the Los Angeles Fair Chance Initiative for Hiring Ordinance, and other applicable laws.
By applying for this job, you agree to receive calls, AI-generated calls, text messages, or emails from Innova Solutions and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy at .

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: 10115307
Position Id: 1016543
Posted 10 hours ago

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