Description A Medical IPA Company in Mid-Wilshire is seeking a dedicated and detail-oriented Grievance and Appeals Specialist to join our team. The ideal candidate will play a crucial role in ensuring our members receive excellent service and fair resolution of grievances and appeals in compliance with regulatory guidelines. This position requires strong analytical skills, superior communication abilities, and a customer-focused mindset to deliver timely and accurate support to our members and healthcare providers. Key Responsibilities: + Manage and resolve member grievances and appeals with sensitivity and professionalism in accordance with company policies and state/federal regulations. + Conduct thorough investigations, reviews, and evaluations of all grievances and appeals, ensuring accurate and timely documentation in applicable systems. + Communicate decisions clearly and effectively to members, providers, agencies, and other stakeholders while maintaining confidentiality and compliance standards. + Monitor and track all grievances and appeals to meet deadlines and regulatory requirements, ensuring adherence to all required timeframes. + Collaborate with clinical and administrative teams to gather necessary information and ensure proper resolution of complex cases. + Provide educational support and guidance to members and staff regarding grievance and appeal processes. + Stay updated on relevant state and federal policies, regulations, and industry trends impacting grievance and appeal procedures. + Assist in identifying process improvement opportunities to enhance member satisfaction and organizational efficiency. Requirements + Minimum 2–3 years of experience in grievance and appeals handling, case management, or a similar role within a healthcare environment. Experience in an IPA, MCO, or other managed care organization highly desirable. + Comprehensive knowledge of medical terminology, claims processes, and healthcare regulations, especially CMS, DHCS, and health plan guidelines. + Strong verbal and written communication skills with the ability to explain complex information clearly and professionally. + Proficiency in Microsoft Office Suite (Word, Excel, and Outlook) and other relevant software tools, including experience with case management systems. + Exceptional organizational skills, attention to detail, and ability to manage multiple priorities in a fast-paced environment. + Ability to analyze complex data and reports while making data-driven decisions. + Strong commitment to member advocacy and providing outstanding customer service. Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles. Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more. Robert Half will consider for employment qualified applicants with arrest or conviction records in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information. © 2025 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https://www.roberthalf.com/us/en/terms) .