Grievances and Appeals (GAD) Coordinator

SCAN Health Plan • Long Beach, CA

18h • Remote

About The Position

The Grievances and Appeals Coordinator coordinates the work of a team of Member Services Representatives providing customer service to members and other associated individuals and groups. The role focuses on intake for Part C and 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.

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.
• Ability to handle complex issues and problems, referring only the most complex issues to higher-level staff.
• Ability to provide leadership, coaching, and/or mentoring to 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.
• A background check is required.

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.
• Ensure member inquiries are addressed and members are referred 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 service offerings or revisions to existing programs based on member feedback or identified needs and coverage gaps.
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED