NEW JOB OPENING
CLINICAL APPEALS REPRESENTATIVE
IN Ontario, CA, USA!

 

Date Posted: 03/13/2026
Hiring Organization: Rose International
Position Number: 498366
Industry: Insurance
Job Title: Clinical Appeals Representative
Job Location: Ontario, CA, USA, 91764
Work Model: Hybrid
Work Model Details: 95% remote with occassional in office for mail
Shift: Mon - Fri 8am - 4:30pm
Employment Type: Temporary
FT/PT: Full-Time
Estimated Duration (In months): 7
Min Hourly Rate($): 23.00
Max Hourly Rate($): 25.00
Must Have Skills/Attributes: Grievance processing, Healthcare
Experience Desired: Experience supporting health plan member grievances (2 yrs); Data entry and documentation tracking experience (2 yrs); Experience managing turnaround times and deadlines in a healthcare environment (1+ yrs)
Required Minimum Education: High School Diploma or equivalent

**C2C is not available**

 

Job Description
Required Skills

• Highschool/GED or equivalent



Desired Skills

• Experience supporting health plan member grievances

• Data entry and documentation tracking experience

• Ability to follow up with provider offices and internal teams

• Experience managing turnaround times and deadlines in a healthcare or insurance environment

• Strong communication and organizational skills



Job Duties

• Point of contact for Health Plan member grievances and internally identified potential quality of care issues (PQI).

• Responsible for coordinating the process with receipt and initial processing, including data entry, record requests and follow ups, for member grievances and other quality of care concerns from internal and external sources.

• Maintains documentation in databases as required.

• Coordinates and communicates with provider offices and other involved entities.

• Ensures documentation is requested and received while managing TATs within Health Plan timelines (24 hours to 10 days, depending on type of request).



Typical Day

• Review incoming grievance and quality of care items

• Perform initial case processing and data entry

• Request records and documentation from provider offices

• Follow up on outstanding items

• Update databases and case records

• Monitor deadlines and keep cases moving within required turnaround times

• Occasionally go into the office to process mail
  • **Only those lawfully authorized to work in the designated country associated with the position will be considered.**

  • **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.**


 

Benefits:
For information and details on employment benefits offered with this position, please visit here. Should you have any questions/concerns, please contact our HR Department via our secure website.

California Pay Equity:
For information and details on pay equity laws in California, please visit the State of California Department of Industrial Relations' website here.

Rose International is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender (expression or identity), national origin, arrest and conviction records, disability, veteran status or any other characteristic protected by law. Positions located in San Francisco and Los Angeles, California will be administered in accordance with their respective Fair Chance Ordinances.

If you need assistance in completing this application, or during any phase of the application, interview, hiring, or employment process, whether due to a disability or otherwise, please contact our HR Department.

Rose International has an official agreement (ID #132522), effective June 30, 2008, with the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services, Employment Verification Program (E-Verify). (Posting required by OCGA 13/10-91.).

 

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About Rose

  • Founded in 1993
  • Office Locations Across the U.S.
  • 150+ Clients: Corporations and Government Agencies
  • Employee Oriented Company
  • Challenging Assignments Across the U.S.
  • Continuous Professional Development

I believe the best thing that Rose HR has going for it is the incredible responsiveness. Everyone is very quick to reply to any concerns, and contacts the contracted employees very quickly and efficiently.

Kevin, Consultant

You are customer service oriented. No matter whether it was the Recruiter or someone in Human Resources/Payroll, you were responsive. That to me is key!

Tonya, Consultant

Your team at Rose International is always very helpful and responsive.

Barbara, Consultant

Rose International maintained good communication during assignments and are very informative through email and phone calls.

Sade, Consultant

Rose International has been great to me. I thank everyone there for all of their hard work; it has not gone unnoticed.

Melody, Consultant

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