Grievance & Appeals Case Analyst TEKsystems Fairfield, CA

• Remote Apply Writing Finance Banking Timelines Operations Leadership Managed Care Communication Investigation Microsoft Word Professionalism Microsoft Excel Problem Solving Law Enforcement Customer Service Microsoft Outlook Business Valuation Deductive Reasoning Organizational Skills Full Stack Development Business Transformation Verbal Communication Skills Healthcare Industry Knowledge At least 1 year $74,880 / yr Posted yesterday

Description:

📍 Fairfield, CA or Redding, CA (100% Onsite) 💰 $36.00/hour 🕒 Monday-Friday | 8:00 AM - 5:00 PM Position Overview Partnership HealthPlan of California is seeking a Grievance & Appeals Case Analyst to investigate, manage, and resolve member grievances and appeals. This role is ideal for someone who enjoys problem-solving, conducting investigations, communicating with members, and managing a high-volume caseload in a fast-paced environment. Responsibilities Manage approximately 50-60 active grievance and appeal cases at a time. Investigate member concerns related to denied services, access to care, provider issues, customer service concerns, and health plan benefits. Gather documentation and evidence to support case investigations. Communicate directly with members regarding case status, next steps, and outcomes. Work closely with internal departments, providers, and external partners to resolve cases. Draft acknowledgment letters, resolution letters, and other case-related correspondence. Maintain accurate case documentation and ensure compliance with regulatory timelines and requirements. Handle sensitive and occasionally escalated member interactions with professionalism and empathy. Qualifications Minimum of 1 year of experience in healthcare, health insurance, managed care, banking, finance, law enforcement, investigations, compliance, customer service, or a related field. Experience managing a high-volume workload or caseload. Strong written and verbal communication skills. Excellent customer service, investigative, and problem-solving abilities. Strong organizational skills and attention to detail. Proficiency with Microsoft Office (Word, Excel, Outlook). Health plan or managed care experience is preferred. Experience with Everest is a plus. Required Assessments Candidates selected to move forward in the process will be required to complete: Workplace Reasoning Assessment (deductive reasoning and problem-solving) Writing Assessment (evaluates writing skills, comprehension, and professional communication) If you're looking for a role where you can make a direct impact on member experience while utilizing your investigative and communication skills, we'd love to hear from you! Job Type & Location This is a Contract position based out of Fairfield, CA. Pay and Benefits The pay range for this position is $36.00 - $36.00/hr. Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: Medical, dental & vision Critical Illness, Accident, and Hospital 401(k) Retirement Plan Pre-tax and Roth post-tax contributions available Life Insurance (Voluntary Life & AD&D for the employee and dependents) Short and long-term disability Health Spending Account (HSA) Transportation benefits Employee Assistance Program Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a hybrid position in Fairfield,CA. Application Deadline This position is anticipated to close on Oct 8, 2026. About TEKsystems We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. About TEKsystems and TEKsystems Global Services Were a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. Were a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. Were strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. Were building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

San Francisco Fair Chance Ordinance:

Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector:

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.

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JP-006308276