Program Assistant, Grievance & Appeals Join us in this amazing opportunity. We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. We are hoping you will join us as a Program Assistant (Grievance & Appeals) and help shape the future of healthcare where you'll be an integral part of our Grievance & Appeals team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Full Office. If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum. Under general supervision, the Program Assistant will assist with specialized services relevant to the Grievance and Appeals Resolution Services (GARS) department. You will work independently, exercising discretion and judgment and may assist in coordinating a function for the program assigned. You will be responsible for monitoring the GARS member and provider mailbox, fax and mail and processing appeals and grievances for assignment to key staff within the required timeframe. Together, we are building a stronger, more equitable health system. Your contributions to the team: 80% - Program Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Serves as the point of contact within or outside CalOptima Health for inquiries related to grievances and appeals. Monitors incoming complaints via the Customer Service system routing, interdepartmental referral, mail, telephone, fax or via email from the website for members and providers. Monitors inquiry requests from the Department of Managed Health Care (DMHC), Medicare Complaint Tracking Module (CTM) from the Centers for Medicare Medicaid Services (CMS), Medicare Quality Improvement Organization (QIO) and the State Hearing Office from Department of Social Services (DSS). Responds to DMHC requests for information in a timely manner. Sets up complaint case files, enters cases in the GARS system with accurate classification and category types and assigns them to appropriate staff. 15% - Administrative Support Works with internal and external departments and providers in gathering supporting information relevant to the case. Generates acknowledgment letters for all lines of business per department and regulatory standards. Assists in the development of departmental forms and intake processes. Coordinates administrative support for state hearings, serves as a contact with DSS for incoming cases, enters cases in the GARS system, creates electronic files and routes the scanned documents to designated staff and fax required state hearing documentation to the local hearing office as necessary. 5% - Completes other projects and duties as assigned. Do you have what the role requires? High school diploma or equivalent PLUS 1 year of experience in appeal and grievance guidelines, Medi-Cal/Medicaid or Medicare programs required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. You'll stand out more if you possess the following: Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese). What the regulatory agencies need you to possess? n/a Your knowledge & abilities to bring to this role: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Your physical requirements (with or without accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Ways we are here for you: You'll enjoy competitive compensation for this role. Our current hiring range is: Pay Grade: 302 - $49,754 - $69,655 ($23.92 - $33.4880). The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. This position is approved for Full Office (**If the position is Telework, it is eligible in California only**) CalPERS pension program and additional retirement packages. Additional benefits and perks including: A generous PTO program A quality work life balance Various wellness programs Tuition Reimbursement Professional development opportunities Career development opportunities Flexible scheduling And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families. Our work environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. Why join us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impact on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's your next step? All applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is March 25, 2026 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close