CTM Coordinator, Appeals & Grievances

Job not on LinkedIn

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $48.4k - $72.6k / year

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Alignment Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

🛡️ Insurance

🏥 Healthcare

💰 $135M Series C on 2020-03

Healthcare Insurance • Insurance • Healthcare

Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.

📋 Description

• Monitor the CTM portal daily for new cases • Acknowledge receipt of CTM grievances and appeals cases • Gather information from members, providers, internal departments, and delegated entities to determine appropriate resolutions • Notify appropriate parties and ensure completion of internal processes before regulatory deadlines • Conduct verbal and written outreach to members and providers in accordance with plan policy and CMS guidelines • Conduct unbiased, accurate, timely, and comprehensive investigations of CTM cases, grievances, and appeals • Document all actions taken to resolve cases in accordance with CMS regulatory timeframes and internal policies • Track cases to closure with timely and comprehensive documentation satisfying CMS requirements • Process CTM cases, grievances, and appeals according to CMS guidelines and plan policy • Draft clear, compliant written responses to CMS within required turnaround times • Prepare objective, accurate, and comprehensive case histories for committee meetings and workgroups • Prepare monthly and quarterly reports • Assist with compliance reporting and regulatory audits • Identify appeal, grievance, and complaint trends, systemic issues, and opportunities to improve member experience and reduce complaint volume • Contribute suggestions supporting strong CMS STAR performance • Participate in reviews and updates of CTM, grievance, and appeal policies and procedures • Participate in CMS audit preparation and regulator meetings and interviews • Meet or exceed internal and regulatory deadlines • Perform other duties as assigned

🎯 Requirements

• At least one year of Member Services or similar experience • 2+ years of experience working with Medicare Advantage healthcare plans • High school diploma or GED • Strong oral and written communication skills • Ability to draft CMS-facing correspondence • High attention to detail and ability to manage multiple deadline-driven cases simultaneously • Ability to type at least 40 words per minute and use a 10-key keypad by touch • Ability to communicate positively, professionally, and effectively; demonstrate leadership; teach; and collaborate across departments • Ability to establish and maintain constructive relationships with diverse members, management, employees, and vendors • Ability to read and interpret safety rules, operating and maintenance instructions, and procedure manuals; write routine reports and correspondence; and speak effectively before groups of customers or employees • Ability to perform basic arithmetic using units of U.S. currency and measurements of weight, volume, and distance • Ability to apply logic and reasoning to address problems efficiently and strategically • Effective problem-solving, organizational, and time-management skills • Preferred: Direct experience working with CTM cases at a Medicare Advantage healthcare plan • Preferred: Associate degree (A.A.) • Preferred: Bilingual in English and Spanish

🏖️ Benefits

• Remote work • Opportunity for growth and innovation • Equal Opportunity/Affirmative Action employment