Grievances and Appeals (GAD) Coordinator

SCAN Health Insurance•Long Beach, CA

7d•$20 - $29•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 Advantage Part C and D Post-Service Appeals.

Requirements

0-3 years of related experience in Grievances and Appeals for a health plan, healthcare, or managed care organization.
Prior experience with Medicare Advantage Part C and D Post-Service Appeals is highly desired.
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

Curious about AI and its power to transform how we operate and serve our members.

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.