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 delivering customer service to members and related individuals and groups.

• Emphasize intake for Part C and D pre-service appeals.

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

• Manage procedures for confirming member identity, membership status, and entitlement to services.

• Keep membership databases and records current and accurate.

• Propose new service offerings or modifications to existing programs based on member input or coverage deficiencies.

• May engage in member retention or renewal initiatives.

• Uphold SCAN's Vision and Goals.

• Carry out additional responsibilities as assigned.

⛳️ Requirements

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

• High school diploma or equivalent experience is mandatory.

• Thorough understanding of grievance and appeals subject matter.

• Strong customer service abilities.

• Capability to perform tasks with minimal supervision.

• Proficiency in addressing complex issues and problems, referring only the most intricate cases to senior staff.

• Experience in leadership, coaching, and/or mentoring a subordinate team; may serve as a lead or first-level supervisor.

• Basic technical competencies in the functional area.

• Basic problem-solving abilities.

• Effective communication and interpersonal skills.

• Advanced skills in Microsoft Office (Word, Excel, PowerPoint, Outlook, Teams).

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

• Background check is required.

🏝️ Benefits

• An annual employee bonus program.

• Comprehensive Wellness Program.

• Generous paid-time-off (PTO).

• Eleven paid holidays each year, in addition to 1 floating holiday and 1 birthday holiday.

• Excellent 401(k) Retirement Saving Plan with employer match and contribution.

• Strong employee recognition program.

• Tuition reimbursement.

• An opportunity to join a team that positively impacts our members and our community every day!