Grievances and Appeals (GAD) Coordinator

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults through Medicare Advantage, fully integrated care models, primary care, and next-generation care delivery.

About the role

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.

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.

Requirements

• 0-3 years of related experience in Grievances and Appeals.
• High school diploma or equivalent experience required.
• 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.
• Basic problem-solving skills.
• Good communication and interpersonal skills.
• Advanced Microsoft Office Skills (Word, Excel, PowerPoint, Outlook, Teams).
• IKA, MHK, or QNXT experience preferred.

Benefits

• 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.

Pay

Base salary range: $20.14 to $29.16 per hour

Schedule

This position schedule will be 4 shifts per week of 10 hours each day, Wed-Sat. Work mode: Remote.