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Grievance and Appeals Specialist (Bilingual Medicaid /Medicare)

22nd Century Technologies, Inc.
Pay Rate: $28/hr on w2 without - W2
United States, California, Orange
Nov 05, 2025
Job Title: Grievance and Appeals Specialist (Bilingual Medicaid /Medicare) Duration: 6+ months Location: Orange, CA 92868 Shift: Monday - Friday; 8:00 a.m. - 5:00 p.m. Pay Rate: $28/hr on w2 without benefits Job Description: 80% - Program Support. Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Serves as the point of contact within or outside CalOptima Health for inquiries related to grievances and appeals. Monitors incoming complaints via the Customer Service system routing, interdepartmental referral, mail, telephone, fax or via email from the website for members and providers. 15% - Administrative Support. Works with internal and external departments and providers in gathering supporting information relevant to the case. Generates acknowledgment letters for all lines of business per department and regulatory standards. Assists in the development of departmental forms and intake processes. Minimum Qualifications: High School diploma or equivalent required PLUS 1 year of experience in appeal and grievance guidelines or Medi-Cal/Medicaid or Medicare programs required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese).