Grievance & Appeals Coordinator RemoteFull-TimeAbout SCANSCAN 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 270,000 members in California, Arizona, and Nevada. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughoutthe 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 with 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 jobFacilitates the member grievance and appeal process by investigating, documenting and preparing case files to meet all regulatory requirements.You 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 the members or providers to request and gather pertinent information. Follow up as needed and document accordingly.
- Refer case to RN or management as needed.
- Track and monitor movement of assigned cases through SCAN's functional units and systems, to ensure compliance with designated timelines.
- 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 benefit structure and maintain current and additional information as it relates to Grievances and Appeals services.
- Utilize department desktop procedures, workflows, job aids and training material. Identify barriers 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.
- Actively support the achievement of SCAN's Vision and Goals.
- Contribute to team effort by accomplishing related results as needed.
- Other duties as assigned.
Your qualifications
- Required: G.E.D./High School
- A comparable combination of education/experience and/or training will be considered equivalent to the education listed above.
- 2+ years in customer service and/or grievance and appeal in Healthcare setting
- Experience providing professional customer service.
- Strong interpersonal skills, including excellent written and verbal communication skills.
- 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: $24
- An 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
- A work-life balance
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. #LI-JR1 Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)