Grievances and Appeals (GAD) Coordinator

SCAN Health Insurance•Long Beach, CA

4d•$20 - $29•Remote

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 position schedule will be 4 shifts per week of 10 hours each day, Wed-Sat. The role involves ensuring member inquiries are addressed and members are referred to appropriate service providers, administering policies for verifying member identity and entitlement to services, and maintaining accurate membership databases. The coordinator may also suggest new service offerings or revisions to existing programs based on member feedback and participate in member retention efforts. The company is seeking individuals who are curious about AI and its potential to transform operations and member services, and who will actively support SCAN’s Vision and Goals. Other duties as assigned.

Requirements

0-3 years of related experience in Grievances and Appeals.
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.
Technical expertise - Basic technical skills for functional area.
Problem Solving - Basic problem solving skills.
Communication - Good communication and interpersonal skills.
Advanced Microsoft Office Skills (Word, Excel, PowerPoint, Outlook, Teams).
Background check is required.

Nice To Haves

IKA, MHK, or QNXT experience 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

Base salary range: $20.14 to $29.16 per hour
Internal title: GAD Coordinator
Work Mode: Mostly Remote
Schedule: 4 shifts per week of 10 hours each day, Wed-Sat.
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!
Competitive compensation and benefits program
Excellent Retirement Savings program
A work-life balance