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Grievance and Appeals Coordinator

Rancho Cucamonga, CA

6.0 Months

Full-Time $17-$22/hr

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Posted: Jun 16, 2026

Ref: NPCATC16

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Position Overview

Under the general direction of the Grievance & Appeals Nurse Manager and Grievance Supervisor, the Grievance and Appeals Coordinator is responsible for completing administrative functions and supporting departmental activities for processing Grievance and Appeal cases. The Grievance and Appeals Coordinator is responsible for ensuring that the client personnel adhere to the guidelines established and outlined in the client Grievance and Appeals Resolution System. The Grievance and Appeals Coordinator exercises independent judgment to ensure appropriate escalation protocols when trends or deficiencies are identified.

Key Responsibilities:
Maintain working knowledge of regulatory guidelines surrounding Grievances per CMS, DHCS, and DMHC.
Understand Member and Provider legal rights to access the Grievance and Appeals Resolution Process, within the respective Provider Organization and the client.
Ensure compliance with the client Grievance and Appeals Resolution Process, in accordance with all Health Plan regulatory agencies.
Responsible for providing administrative support to ensure grievance and appeal cases are processed per regulatory guideline and internal department protocol including:
Coordinate, document and track all client Member and Provider grievances and appeals.
Generates written correspondence to Providers, Members, and regulatory entities using appropriate grammar and punctuation.
Ensure all appropriate grievance and appeal letters are sent out within regulatory compliance guidelines.
Assist the client personnel in filing, tracking, and closing Member and Provider grievances.
When designated to intake cases, the Grievance and Appeals Coordinator will ensure the following:
Assign new cases as received for medical urgency and assign to appropriate Grievance Team Member for investigation and resolution.
Alert assigned Team Member to any immediate needs, provide guidance regarding depth of investigation, best investigative approach, and manner of documentation, such as close oral case as a “1-day” (no written notification required), obtain verbal or written response from provider as indicated, or resolve internally with no provider input required.
Act as a liaison between client departments to coordinate information and close grievances and appeals within regulatory timelines.
Keep the Grievance and Appeals Supervisor aware of “open” & “pending” grievance/appeal issues and expected resolution measures.
Maintain and prepare grievance and appeals summary reports, as needed.
Assist client management in the assessment of grievance and appeal information for the potential change to client policies and procedures.
Responsible for working with Team Members to support the protocols and goals of the department and the vision of the organization.
Demonstrate a commitment to incorporate LEAN principles into daily work.
Speak to health plan members as needed to clarify or obtain any information necessary in order to process a Grievance or an Appeal appropriately.
Speak to health plan members as needed to answer any questions regarding their case

Education & Experience
Three or more (3+) years of administrative experience in an office environment, including use of Microsoft Office Suite. Demonstrated superior interpersonal and administrative skills commensurate with years of experience
Preferred: Experience in a managed care Member Service/Customer Service environment. Prior Medi-Cal and Medicare experience helpful. Previous experience documenting and resolving Member and Provider grievances and appeals
High school diploma or GED required
Bachelor’s degree from an accredited institution preferred

Key Qualifications
Excellent communication and interpersonal skills
Strong organizational skills, typing 45 words per minute, proficient in Microsoft Word and Excel, and data entry experience are essential.
Telephone courtesy
Ability to handle multiple tasks
Strong attention to detail and ability to prioritize work to ensure adherence to task deadlines
Ability to learn and follow standards and procedures
Positive Attitude and ability to work in a team setting

Notes:
Hybrid

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

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Competitive Benefits

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Health & Future Fully Covered

At VIVA, employee well-being is paramount. Our comprehensive benefits package ensures your health, financial security, and quality of life are always prioritized.

Health Insurance

VIVA provides employees access to a comprehensive group health insurance plan (Medical, Dental, Vision, Basic Life, Term Life, and Accidental Death) through our flexible PPO plan-allowing you the freedom to choose healthcare providers.

401(k) Retirement Planning

Plan securely for your future with automatic payroll deductions into a tax-advantaged 401(k) retirement plan, including employer-matching contributions for eligible employees.

Performance Bonuses & Referrals

Earn performance-based bonuses and generous referral incentives of up to $500 when recommending talented candidates who become part of the VIVA family.

Biweekly Direct Deposit

Enjoy timely and convenient payroll with biweekly direct deposit to your chosen financial institution. Biweekly Direct Deposit

VIVA Perks Program

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