Senior Grievance & 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. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do.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.Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity.At SCAN, we believe scale should strengthen—not dilute—our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.The JobThe Grievances and Appeals Senior Coordinator will provide support to grievance and appeal team supervisors through support/guidance to team members, review of cases prior to closure and monitoring compliance with regulations for the team.You WillInvestigate member grievance and appeal by gathering supporting documentation from internal departments, contracted Provider Organizations (PO) and non-contracted entities as indicated.Communicate with members or providers to request and gather pertinent information. Follow up as needed and document accordingly.Refer cases to RN or management as appropriate.Responsible for the complex grievances and appeals, providing support for escalated issues and tasks. Serve as a resource for team members.Track and monitor movement of assigned cases through SCAN’s functional units and systems, to ensure compliance with designated timelines. Partner with clinical staff to complete assigned cases to meet regulatory and compliance requirements.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’s benefit structure and maintains current and additional information as it relates to Grievances and Appeals services.Utilize department desktop procedures, workflows, job aids and training material. Identify barriers and potential solutions 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.Contribute to team effort by accomplishing related results as neededWe seek Rebels who are curious about AI and its power to transform how we operate and serve our members.Actively support the achievement of SCAN’s Vision and Goals.Other duties as assigned.Your Qualifications3+ years of grievance and appeals experience with a Health Plan, Managed Care, or Healthcare organziation.Knowledge of Medicare Part D Pharmacy benefits, rules and regulations is required.Experience providing professional customer service.Associate's Degree or equivalent experience.Technical expertise - Advanced analytical skills. Microsoft Office (Word, Excel, PowerPoint, Access, Outlook, Teams), OneNote, and SharePoint at advance level are required. IKA, MHK, and/or QNXT experience is highly desired.Problem Solving - Advanced problem-solving skills.Communication - Advanced communication and interpersonal skills. Excellent writing skills and the ability to express ideas concisely and clearly orally and in writing. Strong interpersonal skills and the ability to multitask and work independently with minimal supervision.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: $21.78 to $31.52 per hourInternal title: GAD Coordinator SrWork Mode: Mostly RemoteAn annual employee bonus programRobust Wellness ProgramGenerous paid-time-off (PTO)Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holidayExcellent 401(k) Retirement Saving Plan with employer match and contributionRobust employee recognition programTuition reimbursementAn 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-MS1#LI-HybridEqual Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThe 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) #J-18808-Ljbffr Scan-Health-Plan