Case Coordinator

1 day ago


Corona, California, United States Pyramid Consulting, Inc Full time
Job Title: Case Coordinator

We are seeking a highly skilled Case Coordinator to join our team at Pyramid Consulting, Inc. in Corona, CA. This is a 06+ Months Contract opportunity with long-term potential.

Job Summary:

The Case Coordinator will be responsible for investigating complaints and grievances, communicating with internal and external clients, and ensuring compliance with regulations and policies.

Key Responsibilities:
  • Investigate and resolve complaints and grievances in a timely and efficient manner.
  • Communicate with clients to gather information and provide updates on case status.
  • Ensure compliance with regulations, policies, and procedures.
  • Partner with internal staff and other departments to resolve issues.
  • Manage case resolution inbox and ensure integrity of departmental database.
  • Participate in departmental meetings, trainings, and audits as requested.
  • Escalate issues to management as necessary to maintain compliance.
Requirements:
  • 3+ years of experience in complaint and grievance process.
  • Strong working knowledge of federal and state regulations, laws, and accreditation standards related to healthcare and managed care organizations.
  • Knowledge of member complaint and grievance processing preferred.
  • Competent working knowledge of client Health Plan benefits plan/contracts/systems strongly preferred.
  • High School / Associate / Bachelor's degree.
What We Offer:

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.


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