Offer summary

Qualifications:

High School diploma or equivalent education/experience., 2+ years in customer service or grievance and appeal in a healthcare setting., Strong interpersonal, written, and verbal communication skills., Analytical and critical thinking skills with the ability to multitask..

Key responsabilities:

Facilitate the member grievance and appeal process by investigating and documenting cases.

Communicate with members and providers to gather necessary information.

Track and monitor cases to ensure compliance with timelines and regulatory standards.

Maintain confidentiality and adhere to quality and compliance standards.

Job description

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 285,000 members in California, Arizona, Nevada, and Texas. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 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

Facilitates 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 weekend 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

E.D./High School or 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 Pay Range: $20.14 - $32.21
Work Mode: Remote
An annual employee bonus program
Robust Wellness Program
Generous paid-time-off (PTO)
11 paid holidays per year, plus 1 additional floating holiday
Excellent 401(k) Retirement Saving Plan with employer match
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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