Appeals and Grievances Representative, Intermediate

Blue Shield of California • Rancho Cordova, CA

1d • $22 - $34 • Hybrid

About The Position

The Clinical Appeals and Grievances team researches and resolves member/subscriber grievances, appeals and complaints, and interprets and explains health plan benefits, policies, and procedures to appellant. The Appeals and Grievances Representative, Intermediate will report to the team’s Operational Supervisor. In this role you will clarify issues, educate members in the process and interpret/explain health plan benefits, policies, procedures and functions to members and providers. You will be responsible for producing complex written correspondence to resolve member grievances, appeals and complaints. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Requirements

• External hires must pass a background check/drug screen.
• Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance.
• All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Responsibilities

• Researches and resolves member/subscriber grievances, appeals and complaints.
• Interprets and explains health plan benefits, policies, and procedures to appellant.
• Clarifies issues.
• Educates members in the process.
• Interprets/explains health plan benefits, policies, procedures and functions to members and providers.
• Produces complex written correspondence to resolve member grievances, appeals and complaints.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed