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Appeals & Grievance Clerk (Temporary)

Company: Alignment Healthcare
Location: Orange
Posted on: January 17, 2020

Job Description:

Alignment Healthcare is seeking an appeals & grievance (A&G) clerk to provide clerical support to the appeals & grievance department.

Essential Duties and Responsibilities

(May include but are not limited to:)

1. Track daily incoming member correspondence in the member database and case assignment.



  • Log, track, and monitor daily incoming appeals & grievances (CTMs, grievances, appeals, fast tracks, etc.,) through multiple channels.
  • Assemble, maintain, and protect all member A&G case files in an organized fashion.
  • Assist with faxing grievance / appeal response requests to appropriate parties for the gathering of all pertinent and relevant information (i.e., medical records, provider statements, etc.,) to resolve member's concerns.
  • Follow up with provider and or medical group to ensure timely receipt of all grievance / appeal responses in a timely manner.
  • Maintain confidentiality and uphold standards for privacy and data integrity and


    security of the appeals and grievance case information.



    • Maintain a positive and professional relationship with Alignment Healthcare staff, providers, members, and regulators.
    • Any other duties as assigned by the department manager or director.

      Supervisory Responsibilities


      This job has no supervisory responsibilities.

      Minimum Qualifications

      To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

      • Education and / or experience: High school diploma or general education degree (GED); or one to three months related experience and / or training; or equivalent combination of education and experience.
      • Certificates, licenses, registrations: None required.
      • Other qualifications:



        • Basic Computer Skills, (Microsoft Outlook, Excel, Word)
        • 10-Key touch typing
        • Minimum typing speed of 30 words per minute (WPM)
        • Excellent written and verbal communication skills
        • Previous front office experience (preferred)

          Skills and Abilities

          • Language Skills: Able to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Able to write routine reports and correspondence.
          • Mathematical Skills: Able to add and subtract two digit numbers and to multiply and divide with 10's and 100's. Able to perform these operations using units of American money and weight measurement, volume, and distance.
          • Reasoning Skills: Able to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.

            Physical Demands

            The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

            • While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
            • The employee is frequently required to walk; stand; reach with hands and arms.
            • The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl.
            • The employee must occasionally lift and / or move up to 10 pounds.
            • Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

              Working Environment

              The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

              • The noise level in the work environment is usually moderate.

                Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

                If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact careers@ahcusa.com.

Keywords: Alignment Healthcare, Orange , Appeals & Grievance Clerk (Temporary), Other , Orange, California

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