Grievances and Appeals Coordinator

🔥 14 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $20 - $29 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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SCAN

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1977

🏥 Healthcare

⚕️ Healthcare Insurance

👥 B2C

Healthcare • Healthcare Insurance • B2C

SCAN is a mission-driven healthcare organization focused on reinventing aging by delivering evidence-based, patient-centered care and coverage for older adults. It operates an integrated portfolio including health insurance plans with innovative benefits, in-home and virtual primary care, support programs for caregivers and homebound older adults, and specialized services for vulnerable populations. SCAN also invests in and partners with companies that advance care models and resources to help older adults remain healthy and independent at home.

📋 Description

• Coordinate the work of a team of Member Services Representatives providing customer service to members and associated individuals and groups • Focus on intake for Part C and D Pre-Service Appeals • Ensure member inquiries are addressed and members are referred to appropriate service providers • Administer policies and procedures for verifying member identity, membership status, and entitlement to services • Maintain current and accurate membership databases and records • Suggest new service offerings or revisions to existing programs based on member feedback or gaps in coverage • May participate in member retention or renewal efforts • Support SCAN’s Vision and Goals • Perform other duties as assigned

🎯 Requirements

• 0-3 years of related experience in Grievances and Appeals • Prior experience with Intake for Part C and D Pre-Service Appeals is highly desired • High school diploma or equivalent experience required • Comprehensive knowledge of grievance and appeals subject matter • Customer service skills • Ability to perform work under minimal supervision • Ability to handle complex issues and problems, referring only the most complex issues to higher-level staff • Ability to provide leadership, coaching, and/or mentoring to a subordinate group; may act as a lead or first-level supervisor • Basic technical skills for the functional area • Basic problem-solving skills • Good communication and interpersonal skills • Advanced Microsoft Office skills (Word, Excel, PowerPoint, Outlook, Teams) • IKA, MHK, or QNXT experience preferred • Background check required

🏖️ Benefits

• An annual employee bonus program • Robust Wellness Program • Generous paid-time-off (PTO) • Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday • Excellent 401(k) Retirement Saving Plan with employer match and contribution • Robust employee recognition program • Tuition reimbursement • Equal pay and inclusive benefits • Opportunity to become part of a team that makes a difference to members and the community