Grievance & Appeals Coordinator

$49,920 - $49,920/Yr

SCAN Health Plan - Long Beach, CA

Full-time

Remote - Long Beach, CA

Ambulatory Health Care Services

About the position

The Grievance & Appeals Coordinator at SCAN Group is responsible for facilitating the member grievance and appeal process, ensuring compliance with regulatory requirements. This role involves investigating and documenting cases, communicating with members and providers, and tracking the progress of cases through various functional units. The coordinator plays a crucial role in maintaining the privacy of members and adhering to quality and compliance standards while supporting SCAN's vision and goals.

Responsibilities

• Investigate member grievances and appeals by gathering supporting documentation from internal departments and contracted Provider Organizations.
• Communicate with members or providers to request and gather pertinent information, following up as needed.
• Refer cases to RN or management as necessary.
• Track and monitor the movement of assigned cases to ensure compliance with designated timelines.
• Respond to requests for information from regulatory agencies within required timeframes.
• Close cases within designated regulatory time requirements and generate appropriate communications.
• Understand SCAN's benefit structure and maintain current information related to Grievances and Appeals services.
• Utilize department procedures and identify barriers to work processes, bringing them to the attention of management.
• Cover weekend on-call rotation as assigned.
• Maintain confidentiality and protect SCAN operations by keeping information secure.
• Adhere to quality, compliance, and regulatory standards to achieve SCAN outcomes.
• Contribute to team efforts by accomplishing related results as needed.

Requirements

• G.E.D./High School diploma or equivalent education/experience.
• 2+ years in customer service and/or grievance and appeal in a healthcare setting.
• Experience providing professional customer service.
• Strong interpersonal skills, including excellent written and verbal communication skills.
• Strong organizational skills and ability to multitask.
• Ability to maintain confidentiality appropriately.
• Strong analytical and critical thinking skills.

Benefits

• Base Salary range: $24
• Annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• Eleven paid holidays per year, plus 1 additional floating holiday
• Excellent 401(k) Retirement Saving Plan with employer match
• Robust employee recognition program
• Tuition reimbursement
• Work-life balance