Grievances and Appeals (GAD) Coordinator
About The Position
The GAD Coordinator coordinates the work of a team of Member Services Representatives who provide customer service to members and other associated individuals and groups. The role focuses on intake for Part C and Part D pre-service appeals. The schedule is Monday through Friday, 8:30 a.m. to 5:30 p.m. Pacific Time, and the position is remote. The coordinator ensures member inquiries are addressed and members are referred to appropriate service providers; administers procedures for verifying member identity, membership status, and service entitlement; and maintains accurate membership databases and records. The role may also suggest service or program changes based on member feedback or identified needs, participate in member retention or renewal efforts, and support SCAN’s vision and goals.
Requirements
- 0–3 years of related experience in grievances and appeals.
- High school diploma or equivalent experience required.
- Comprehensive knowledge of grievance and appeals subject matter.
- Customer service skills.
- Ability to perform work under minimal supervision and handle complex issues, referring only the most complex issues to higher-level staff.
- Leadership, coaching, or mentoring experience with a subordinate group; may act as a lead or first-level supervisor.
- Basic technical skills for the functional area.
- Basic problem-solving skills.
- Good communication and interpersonal skills.
- Advanced Microsoft Office skills, including Word, Excel, PowerPoint, Outlook, and Teams.
Nice To Haves
- Experience with IKA, MHK, or QNXT.
Responsibilities
- Coordinate the work of a team of Member Services Representatives providing customer service to members and associated individuals and groups.
- Handle intake for Part C and Part D pre-service appeals.
- Ensure member inquiries are addressed and refer members to appropriate service providers.
- Administer procedures for verifying member identity, membership status, and entitlement to services.
- Maintain current and accurate membership databases and records.
- Suggest new services or revisions to programs based on member feedback, needs, or gaps in coverage.
- May participate in member retention or renewal efforts.
- Support the achievement of SCAN’s vision and goals.
- Perform other duties as assigned.
Benefits
- Annual employee bonus program
- Robust wellness program
- Generous paid time off
- Eleven paid holidays per year, plus one floating holiday and one birthday holiday
- 401(k) retirement savings plan with employer match and contribution
- Employee recognition program
- Tuition reimbursement
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
