Grievances and Appeals (GAD) Coordinator

SCAN Health Plan • Long Beach, CA

9d • Hybrid

About The Position

The GAD Coordinator coordinates the work of a team of Member Services Representatives that provide customer services to members and other associated individuals and groups. This role will focus on Medicare Part C and D Grievances and will be "closers".

Requirements

• 0-3 years of related experience in Grievances and Appeals for a health plan, healthcare, or managed care organization.
• Current or prior experience with Medicare Part C and D Grievances and working on closing out grievances is highly desirable.
• High school diploma or equivalent experience required.
• Possesses comprehensive knowledge of subject matter (grievance and appeals).
• Customer service skills.
• Performs work under minimal supervision.
• Handles complex issues and problems, and refers only the most complex issues to higher-level staff.
• Provides leadership, coaching, and/or mentoring to a subordinate group.
• May act as a lead or first-level supervisor.
• Basic technical skills for functional area.
• Advanced Microsoft Office (Word, Excel, PowerPoint, Outlook, Teams) are required.
• IKA, MHK, or QNXT preferred.
• Basic problem solving skills.
• Good communication and interpersonal skills.

Nice To Haves

• Current or prior experience with Medicare Part C and D Grievances and working on closing out grievances is highly desirable.
• IKA, MHK, or QNXT preferred.

Responsibilities

• Ensure that member inquiries are addressed and that members are referred to the appropriate service provider(s).
• Administer policies and 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 in response to member needs or gaps in coverage.
• May participate in member retention or renewal efforts.
• Actively support the achievement of SCAN’s Vision and Goals.
• Other duties as assigned.

Benefits

• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
• Excellent 401(k) Retirement Saving Plan with employer match and contribution
• Robust employee recognition program
• Tuition reimbursement
• An opportunity to become part of a team that makes a difference to our members and our community every day!

What This Job Offers

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