Customer Solution Center Appeal and Grievance Compliance Advisor

The Customer Solution Center Appeal and Grievance Compliance Advisor is responsible for ensuring regulatory compliance and audit readiness for the Customer Solution Center. This includes developing audit strategies, conducting audits, and recommending corrective actions. The Specialist will work closely with management to ensure compliance with regulatory requirements and will lead audit situations and present findings to management.

Requirements

• A minimum of 5 years experience in regulatory auditing (Appeals & Grievances, Call Center, Enrollment) in a healthcare environment
• Previous experience with Medi-Cal and Medicare in a managed care environment
• Bachelors Degree required