Aroha Technologies, Inc

Grievance Resolution Specialist (Provider Resolution)

ORANGE, CAPosted 21 days ago

Job summary

  • Job post source

    This job is directly from Aroha Technologies, Inc representing CalOptima Health.

  • Job overview

    The Grievance Resolution Specialist (Provider Resolution) is a temporary role focused on coordinating and resolving grievances and appeals related to member eligibility, benefits, claims, and provider disputes to ensure optimal resolution and compliance.

  • Responsibilities and impact

    The specialist will manage grievance and appeal cases, communicate with members, providers, and internal teams, gather and evaluate information, develop resolution correspondence, ensure policy compliance, identify trends, and meet performance goals.

  • Experience and skills

    Requires at least 1 year of experience in Provider Dispute Resolution in Medicare and Medi-Cal, with additional experience in grievances, appeals, claims administration, or related fields; preferred qualifications include an associate degree and bilingual skills.

  • Work environment and culture

    The role supports a mission-driven culture emphasizing high-quality performance, customer service, dignity, and accountability within a collaborative team environment.

  • Company information

    CalOptima Health is a healthcare organization focused on providing services related to Medicare and Medi-Cal, working with various health networks and regulatory bodies.

  • Team overview

    The position is within the GA - Provider Disputes department, collaborating with internal departments like Customer Service, Provider Relations, Pharmacy, and Medical Management.

  • Job location and travel

    The job is full office/onsite with a Monday to Friday schedule from 8:00 a.m. to 5:00 p.m.

  • Unique job features

    The job involves working with regulatory compliance, provider contracts, and requires coordination across multiple internal and external stakeholders to resolve grievances and appeals efficiently.

Company overview

Aroha Technologies, Inc. is an information technology outsourcing and placement company based in Lexington, Massachusetts. The company specializes in providing IT project management services, with a focus on contracting roles, particularly for W2 candidates. Aroha Technologies also engages in hiring international talent through H-1B visa sponsorship, indicating a diverse and skilled workforce. The company generates revenue by placing IT professionals in various project management and technical roles across different industries.

How to land this job

  • Position your resume to highlight your experience with provider dispute resolution, particularly in Medicare and Medi-Cal appeals and denials, as these are central to the role at Aroha Technologies, Inc.

  • Emphasize your skills in grievance and appeal coordination, data management, case evaluation, and your ability to communicate effectively with both internal teams and external providers or members.

  • Apply through multiple platforms including Aroha Technologies, Inc's corporate careers page and LinkedIn to maximize your chances of being noticed for the Grievance Resolution Specialist role.

  • Connect with current employees in the Provider Disputes or related departments at Aroha Technologies, Inc on LinkedIn; initiate conversations by asking about their experience with grievance resolution processes or commenting on recent company initiatives in healthcare compliance.

  • Optimize your resume for ATS by integrating keywords from the job description such as 'grievance resolution,' 'provider dispute,' 'Medicare and Medi-Cal appeals,' 'case management,' and 'regulatory compliance' to ensure it passes automated screening.

  • Leverage Jennie Johnson's Power Apply feature to automate tailored applications, identify multiple application portals, and find relevant LinkedIn contacts, allowing you to focus your energy on preparing for interviews and networking effectively.

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