About US: At Cogent Infotech, we believe in creating opportunities that empower individuals and transform organizations. With over 21 years of excellence in consulting and talent solutions, we pride ourselves on building inclusive workplaces and driving innovation in everything we do. Our diverse teams bring unique perspectives to help deliver cutting-edge solutions to global clients across both public and private sectors. Job Title: Grievance Resolution Specialist (Provider Resolution) Location: Orange, CA (92868) Duration: Contract Shift: Monday – Friday 8:00 am – 5:00 pm Pay: USD 26/hr – USD 28/hr Description : The client is hiring a Temporary Grievance Resolution Specialist to handle provider-related complaints and appeals. The role involves coordinating resolutions, responding to member and provider concerns, and working closely with internal teams and external stakeholders. Strong experience in healthcare grievance processes is required. Responsibilities: + Program Support - Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. + Maintains adequate information in client’s systems; ensures data collection, summarization, integration and reporting which includes case creation and management and events/activity tracking. + Gathers pertinent information regarding the grievances and appeals received, including member or provider concerns, supporting information related to initial decision-making, new information supporting the grievance or appeal or supplemental information required to evaluate grievances and appeals within regulatory requirements. + Evaluates case details, proposes recommendations or makes decisions as applicable and ensures the organization’s decision is implemented according to the Grievance and Appeals policies and case resolution. + Reads and interprets provider contracts, Division of Financial Responsibility (DOFR), policies, procedures and instructions. + Responds to routine provider inquiries via phone, assisting with provider appeals resolution inquiries. + Meets performance measurement goals for Grievance and Appeals Resolution Services. Minimum Qualifications: + High school diploma or equivalent PLUS 1 year of experience with Provider Dispute Resolution (PDR) in Medicare and Medi-Cal in professional, institutional, outpatient, ancillary, coordination of benefits and government cases required. + 1 year of experience with Medicare or Medi-Cal provider appeals and denials process required. + 1 year of experience in any of the following areas: Grievances and Appeals, Claims Administration, Regulatory Compliance, Customer Service or related field required. Preferred Qualifications: + Associate degree in business, health care administration or related field. + Experience in health care practice standards, for both government and commercial plans. + Bilingual in English and in one of client’s defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish or Vietnamese). Required Licensure / Certifications: N/A Application Process Resume Review Initial discussion Video Screening Client Interview Cogent Infotech is a leading tech consulting firm headquartered in Pittsburgh, PA, offering cutting-edge digital transformation solutions in Cloud, Cybersecurity, Data Analytics and AI. ISO-certified and CMMI Level 3 appraised, we proudly partner with 70+ Fortune 500 companies and 150+ government agencies. Cogent is an equal opportunity employer and does not discriminate based on any protected status under applicable law.