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Customer Solution Center Appeals and Grievances Training Specialist II

Job Category:  Administrative, HR, Business Professionals
Department:  CSC Appeals & Grievance

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  6782


Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.


“As a condition of employment, L.A. Care requires a COVID-19 vaccine. This requirement includes our remote workforce. If you would like to request an exemption, L.A. Care has implemented a process to consider exemptions, for documented medical conditions and sincerely held religious beliefs. L.A. Care will review all exemption requests prior to proceeding with the recruitment process.”

Job Summary

The Customer Solutions Center Appeals and Grievances (A&G) Training Specialist II is primarily responsible for the overall training strategy across the department. This position designs and conducts training programs using established regulatory and departmental guidelines. This position is responsible for providing ongoing training on the core processing system, A&G processing procedures, training regulatory changes which will affect established procedures, working with the quality team on quality and performance guidelines, creating and maintaining departmental policy and procedures. Additional responsibilities include evaluating initial training and ongoing learning opportunities to achieve consistency, efficiency, and productivity among the staff.


Applies knowledge and skills to build competencies for the design of training programs that will boost employee’s workplace performance in alliance with Enterprise and departmental goals. Responsible for performing training needs assessments with the department management and will leads the design and delivery of  curriculum and learning materials to ensure the success of new and current staff.


Conducts training for Customer Solution Center A&G team in customer service, product operations, and other work processes. Conducts training sessions covering specified areas such as on-the-job training, use of computers and software, interpersonal skills, quality & process issues, and product knowledge.


Maintain documentation, including database/system updates, training agendas, sign-in sheets, etc. to demonstrate trainee compliance with department requirements.


Work with key stakeholders to monitor error trends, productivity, and quality standards for the program. Identifies gaps in knowledge, skills and abilities, assess and recommend training/education measures to resolve issues and enhance staff performance.


Propose program modifications to enhance performance and positively influence member satisfaction survey results.


Conduct assessments after training  to measure, record, and report feedback on training material and sessions. Serve as coach staff to handle problems and concerns as they arise.


Review and recommends updates on policy and procedure critical to claims process.


Perform other duties as assigned.

Education Required

Bachelor's Degree in Business Administration or Healthcare Related Field
In lieu of degree, equivalent education and/or experience may be considered.

Education Preferred


A minimum of 3-5 years of Managed Care, Medicaid, Medicare experience required.


A minimum of 3-5 experience in design and delivery (facilitating and coordinating) of training programs.


Strong understanding of learning principles and ability to demonstrate in classroom (or virtual classroom) situations.


Knowledge of CA regulatory guidelines, Medi-Cal guidelines, Medicare guidelines, NCQA requirements.


Skilled in group facilitation and managing effective discussion and dialogue to enhance the learning experience.


Strong organizational & analytical skills.


Ability to conduct effective and engaging presentations in a variety of delivery settings.


Ability to interpret technical data, processes, operating and maintenance instructions and procedure manuals.


Must be a strong team player willing to work toward achieving team goals. Must be flexible to meet the changing training needs.


Professional demeanor. Commitment to Team Culture.


Excellent written and verbal communications skills.


Proficient using Word, Excel, Power Point and Access. 

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Additional Information


L.A. Care offers a wide range of benefits including

  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program
  • Volunteer Time Off (VTO)


At L.A. Care, we value our team members’ safety. In order to keep our work locations safe, each employee is required to self-screen for symptoms prior to entering any L.A. Care location each day. L.A. Care and all of its staff are required to comply with all state and local masking orders. Therefore, when on-site at any L.A. Care location, employees are expected to wear a mask in areas where physical distancing cannot be managed.


Nearest Major Market: Los Angeles

Job Segment: Medical, Claims, Medicare, Medicaid, Healthcare, Insurance

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