Grievances and Appeals Coordinator

Role Overview

• 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

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)
• IKA, MHK, or QNXT experience preferred.

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