Senior Grievance & Appeals (GAD) Coordinator
$45,302–$65,562 year
Remote · United States or Long Beach, California, United States
Job Summary
Senior Grievance & Appeals Coordinator provides support to grievance and appeal team supervisors, investigates member grievances and appeals by gathering documentation from internal departments and external providers, ensures timely regulatory compliance, collaborates with clinical staff, and manages case movement through SCAN’s processes. The role requires handling complex grievances and appeals, supporting escalated issues, maintaining privacy and confidentiality, and participating in on-call rotation. The position is mostly remote with a Long Beach office option and includes a robust benefits package and professional development opportunities.
Required Qualifications
- 3+ years of grievance and appeals experience with a Health Plan, Managed Care, or Healthcare organization
- Knowledge of Medicare Part D Pharmacy benefits, rules and regulations
- Associate's Degree or equivalent experience
- Advanced analytical skills
- Microsoft Office (Word, Excel, PowerPoint, Access, Outlook, Teams), OneNote, and SharePoint at advance level
- IKA, MHK, and/or QNXT experience is highly desired
- Problem solving and communication skills
- Strong written communication and interpersonal skills
- Confidentiality compliance
- Ability to multi-task and work independently
Desired Qualifications
- 3+ years of grievance and appeals experience with a Health Plan, Managed Care, or Healthcare organization
- Knowledge of Medicare Part D Pharmacy benefits, rules and regulations
- Associate's Degree or equivalent experience
- Advanced analytical skills
- Microsoft Office (Word, Excel, PowerPoint, Access, Outlook, Teams), OneNote, and SharePoint
- IKA, MHK, and/or QNXT experience highly desired
- Excellent writing and communication skills
- Ability to multitask and work independently with minimal supervision
- Strong confidentiality and privacy practices
- Background check required
Additional Requirements
- Background check required
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