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 support to members and relevant individuals and groups.

• Ensure that member inquiries are resolved effectively and direct members to the suitable service providers.

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

• Maintain up-to-date and precise membership databases and records.

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

• May engage in member retention or renewal initiatives.

• Uphold SCAN’s Vision and Goals.

• Execute other responsibilities as assigned.

⛳️ Requirements

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

• A high school diploma or equivalent experience is required.

• Extensive knowledge of grievance and appeals processes.

• Strong customer service abilities.

• Capability to work with minimal supervision.

• Proficiency in handling complex issues and problems, forwarding only the most intricate matters to senior staff.

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

• Basic technical skills relevant to the functional area.

• Fundamental problem-solving abilities.

• Strong communication and interpersonal skills.

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

• Background check is required.

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

🏝️ Benefits

• An annual employee bonus program.

• Comprehensive Wellness Program.

• Generous paid-time-off (PTO).

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

• Exceptional 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 community every day!