Teams at Community Health Group

Provide high-level administrative support to the Director of Claims and Customer Service: scheduling, correspondence, document preparation, reports and spreadsheets, committee coordination, supply/equipment management, filing and confidentiality, and special project support.

Provide Medicare member support and care coordination through home visits, phone outreach, scheduling, interpreter/transportation/prior authorization facilitation, documentation, grievance referral, and community resource linkage. Participate in on-call rotations and complete welcome calls.

Support Appeals Manager by investigating and resolving member grievances and appeals per Medicare/Medi‑Cal regulations. Use QNXT and Innovare to gather eligibility, claims, and case data, communicate findings, prepare decision letters, escalate quality‑of‑care issues, compile compliance reports, and liaise with providers and internal departments to meet timeliness and regulatory requirements.