Senior Coordinator - Grievance & Appeals (GAD)

About SCAN

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 300,000 members in California, Arizona, Nevada, Texas and New Mexico. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 45 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.

The Job

The Grievances and Appeals Senior Coordinator will provide support to grievance and appeal team supervisors through support/guidance to team members, review of cases prior to closure and monitoring compliance with regulations for the team

You Will

• The Grievances and Appeals Coordinator Senior will investigate member grievance and appeal by gathering supporting documentation from internal departments, contracted Provider Organizations (PO) and non-contracted entities as indicated.
• Communicate with members or providers to request and gather pertinent information. Follow up as needed and document accordingly.
• Refer cases to RN or management as appropriate.
• Responsible for the complex grievances and appeals, providing support for escalated issues and tasks. Serve as a resource for team members.
• Track and monitor movement of assigned cases through SCAN's functional units and systems, to ensure compliance with designated timelines. Partner with clinical staff to complete assigned cases to meet regulatory and compliance requirements.
• Respond to requests for information from all regulatory agencies within required timeframes.
• Respond to and close cases within designated regulatory time requirements as identified by case types. Generate and send appropriate communications.
• Understand SCAN's benefit structure and maintains current and additional information as it relates to Grievances and Appeals services.
• Utilize department desktop procedures, workflows, job aids and training material. Identify barriers and potential solutions to work processes and bring to the attention of the supervisor/manager.
• Cover week-end on call rotation as assigned. Maintain the member's right to privacy and protect SCAN operations by keeping information confidential.
• Adhere to all quality, compliance and regulatory standards to achieve HCS and SCAN outcomes.
• Contribute to team effort by accomplishing related results as needed
• We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.
• Actively support the achievement of SCAN's Vision and Goals.
• Other duties as assigned.

Your Qualifications

• 3+ years customer service and/or grievance and appeals experience in a Healthcare setting.
• Knowledge of Medicare Part D Pharmacy benefits, rules and regulations.
• Experience providing professional customer service.
• Associate's Degree or equivalent experience
• Technical expertise - Advanced analytical skills
• Problem Solving - Advanced problem-solving skills
• Communication - Advanced communication and interpersonal skills. Excellent writing skills and the ability to express ideas concisely and clearly orally and in writing. Strong interpersonal skills and the ability to multitask and work independently with minimal supervision.
• Strong organizational skills; Ability to multitask.
• Ability to appropriately maintain confidentiality.
• Strong analytical and critical thinking skills, required.

What's in it for you?

• Base salary range: $21.78 to $31.52 per hour
• Internal title: GAD Coordinator Sr
• Work Mode: Mostly Remote
• 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!

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

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