Offer summary

Qualifications:

High School diploma or G.E.D. required., At least 2 years of experience in customer service or healthcare grievance and appeals., Strong communication and organizational skills., Ability to maintain confidentiality and analyze information effectively..

Key responsibilities:

Investigate member grievances and appeals by gathering supporting documentation.

Communicate with members, providers, and internal departments to collect information.

Track case progress to ensure compliance with regulatory timelines.

Respond to regulatory agencies and close cases within required timeframes.

About SCAN Keeping Seniors Healthy and Independent–that’s been our mission for more than 40 years. Founded in Long Beach, CA in 1977 by a group of senior activists committed to improving access to the care and services they needed as they aged, SCAN is a recognized leader in senior care. As one of the nation’s largest not-for-profit Medicare Advantage plans, SCAN also provides a range of community services, including the innovative programs of Independence at Home and robust community education and community giving. The SCAN mission is not something that just hangs on the wall, it’s a commitment understood and embraced by every employee. We believe in supporting our employees so they, in turn, can support our members as well as seniors and caregivers in the communities we serve. That means providing training, tools and opportunities for growth—and rewarding jobs well done. Our employees enjoy: - A competitive compensation and benefits program - An annual employee bonus program - Generous paid-time-off (PTO) - Ten paid holidays per year - Excellent 403(b) Saving Plan, providing up to 4% match and vesting after three years - Casual attire . . . wear jeans every day!! - A work-life balance and much more! Want to learn more about SCAN? Visit us at scanhealthplan.com

Grievance & Appeals Coordinator

Remote

FullTime

About SCAN

SCAN Group is a notforprofit 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 notforprofit Medicare Advantage plans, serving more than 300,000 members in California, Arizona, Nevada, and Texas. SCAN has been a missiondriven 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 with indepth training and access to stateoftheart 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 noncontracted 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 supervisormanager.

Cover weekend oncall 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 educationexperience andor training will be considered equivalent to the education listed above.

2+ years in customer service andor 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

Work Mode Remote

An annual employee bonus program

Robust Wellness Program

Generous paidtimeoff (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 worklife balance

An opportunity to become part of a team that makes a difference to our members and our community every day!

Were 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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