Member Appeals and Grievances Coordinator

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⚔️ Virginia – Remote

⚔️ Virginia – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Sentara Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1890

⚕️ Healthcare Insurance

Healthcare Insurance

Sentara Health is a leading healthcare system that operates over 300 sites of care in Virginia and northeastern North Carolina, including 12 acute care hospitals. The company is dedicated to providing exceptional patient care, fostering professional development, and maintaining a diverse workforce. Sentara Health aims to improve health every day and has been recognized for its clinical and operational performance, being named one of the top 15 health systems by IBM Watson Health. The organization supports its employees in achieving their full potential and encourages growth and innovation in the healthcare sector.

📋 Description

• Responsible for the investigation and documentation of member appeals and grievances in compliance with State law, applicable rules and regulations and provider and group agreements. • Works closely with the Plan's Medical Directors who are responsible for all decision regarding clinical appeals/ grievances and the Appeals Manager who is responsible for non-clinical appeals and grievances.

🎯 Requirements

• HS - High School Grad or Equivalent REQUIRED • Managed Care- 3 years REQUIRED • Previous member appeals and grievances experience preferred • Experience in JIVA and Medicaid preferred

🏖️ Benefits

• Medical, Dental, Vision plans • Adoption, Fertility and Surrogacy Reimbursement up to $10,000 • Paid Time Off and Sick Leave • Paid Parental & Family Caregiver Leave • Emergency Backup Care • Long-Term, Short-Term Disability, and Critical Illness plans • Life Insurance • 401k/403B with Employer Match • Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education • Student Debt Pay Down – $10,000 • Reimbursement for certifications and free access to complete CEUs and professional development • Pet Insurance • Legal Resources Plan • Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.