Grievances and Appeals Coordinator

This is a fully remote position, open to applicants in California.

📋 Description

• Oversee the activities of a team of Member Services Representatives who deliver customer service to members and related individuals and groups.

• Concentrate on the intake process for Part C and D Pre-Service Appeals.

• Ensure that member inquiries are resolved and that members are directed to the appropriate service providers.

• Implement policies and procedures to verify member identity, membership status, and eligibility for services.

• Keep membership databases and records up-to-date and accurate.

• Propose new service offerings or modifications to existing programs based on member feedback or identified gaps in coverage.

• May engage in efforts related to member retention or renewal.

• Contribute to SCAN’s Vision and Goals.

• Carry out additional responsibilities as assigned.

⛳️ Requirements

• 0-3 years of relevant experience in Grievances and Appeals.

• Previous experience with Intake for Part C and D Pre-Service Appeals is strongly preferred.

• A high school diploma or equivalent experience is necessary.

• Thorough knowledge of grievance and appeals subject matter.

• Strong customer service abilities.

• Capability to work with minimal supervision.

• Skill in managing complex issues and problems, escalating only the most challenging ones to higher-level staff.

• Capacity to provide leadership, coaching, and/or mentoring to a subordinate group; may serve as a lead or first-level supervisor.

• Basic technical skills relevant to the functional area.

• Fundamental problem-solving skills.

• Effective communication and interpersonal skills.

• Proficient in advanced Microsoft Office applications (Word, Excel, PowerPoint, Outlook, Teams).

• Experience with IKA, MHK, or QNXT is preferred.

• A background check is required.

🏝️ Benefits

• An annual employee bonus program.

• A comprehensive Wellness Program.

• Generous paid-time-off (PTO).

• Eleven paid holidays each year, in addition to one floating holiday and one birthday holiday.

• An excellent 401(k) Retirement Saving Plan with employer matching and contributions.

• A robust employee recognition program.

• Tuition reimbursement.

• Equal pay and inclusive benefits.

• An opportunity to join a team that positively impacts members and the community.