Program Assistant - Grievance & Appeals

Program Grievance & Appeals Specialist

Position Information

Department: Grievance & Appeals

Hourly: $23/hr $32/hr) depending on experience

Schedule: Monday–Friday, 8:00 a.m.–5:00 p.m.

Location: Orange, CA

Duties & Responsibilities

Program Support

• Contributes to a mission‑driven culture focused on high-quality performance, customer service, consistency, dignity, and accountability.
• Supports departmental responsibilities and collaborates on short‑ and long‑term goals.
• Serves as the primary contact for internal and external inquiries related to grievances and appeals.
• Monitors incoming complaints through Customer Service routing, interdepartmental referrals, mail, phone, fax, and website submissions.
• Tracks inquiries from DMHC, CMS Medicare CTM, Medicare QIO, and DSS State Hearings.
• Responds to DMHC information requests promptly.
• Creates complaint case files, enters cases into the GARS system with accurate classifications, and assigns cases to appropriate staff.
  
  

Administrative Support

• Works with internal/external departments and providers to gather case-related information.
• Generates acknowledgment letters for all lines of business in compliance with regulatory standards.
• Assists in developing departmental forms and intake processes.
• Provides administrative support for state hearings, including communication with DSS, case entry into GARS, electronic file creation, document routing, and faxing required materials.
  
  

Minimum Qualifications

• High school diploma or equivalent required.
• Plus 1 year of experience in appeals and grievance guidelines or Medi-Cal/Medicaid/Medicare programs.
• Equivalent combinations of education and experience may be considered.
  
  

Preferred Qualifications

• Bilingual in English and one of the following: Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese.
  
  

Knowledge & Abilities

• Build rapport and maintain effective working relationships with staff, leadership, and external partners.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely in writing and verbally.
• Work flexible hours, including occasional evenings and weekends.
• Organize, analyze, problem‑solve, and manage projects effectively.
• Perform efficiently in a fast‑paced environment.
• Manage multiple projects and identify collaboration opportunities.
• Motivate and lead multi‑program teams and external committees.
• Use computers and software such as Microsoft Word, Outlook, Excel, PowerPoint, and job‑specific systems.
  
  

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