SCAN
SCAN
SCAN yra misijos vedama sveikatos priežiūros organizacija, siekianti padėti vyresnio amžiaus žmonėms gyventi sveikiau ir savarankiškiau. 1977 m. įkurta organizacija derina sveikatos draudimą su įrodymais pagrįstomis, į pacientą orientuotomis paslaugomis, įskaitant pirminę sveikatos priežiūrą namuose ir nuotoliniu būdu, pagalbą slaugytojams, namuose gyvenantiems suaugusiesiems skirtas programas ir specializuotą pažeidžiamų gyventojų grupių priežiūrą. SCAN taip pat bendradarbiauja su organizacijomis, kuriančiomis naujus priežiūros modelius ir išteklius, padedančius žmonėms senti namuose, ir į jas investuoja.

Grievances and Appeals Coordinator – Medicare Part C and D | SCAN

Coordinate Medicare Part C and D grievance resolution and support members and service teams at SCAN, a nonprofit health organization serving older adults.

Aprašymas

  • Lead Member Services Representatives who assist members and related individuals and groups.
  • Handle Medicare Part C and D grievances through resolution.
  • Respond to member inquiries and connect members with appropriate service providers.
  • Apply procedures to verify member identity, enrollment status, and eligibility for services.
  • Keep membership databases and records accurate and up to date.
  • Recommend service or program changes based on member feedback and coverage gaps.
  • Support member retention or renewal efforts as needed.
  • Advance SCAN’s vision and goals.
  • Carry out other assigned duties.

Reikalavimai

  • 0–3 years of related experience handling grievances and appeals for a health plan, healthcare provider, or managed care organization.
  • Current or previous experience resolving Medicare Part C and D grievances is highly desirable.
  • High school diploma or equivalent experience required.
  • Comprehensive knowledge of grievance and appeals matters.
  • Customer service skills.
  • Ability to work with minimal supervision.
  • Ability to manage complex issues and refer only the most complex cases to higher-level staff.
  • Ability to lead, coach, or mentor a subordinate group; may serve as a lead or first-level supervisor.
  • Basic technical skills relevant to the role.
  • Advanced Microsoft Office skills, including Word, Excel, PowerPoint, Outlook, and Teams.
  • Experience with IKA, MHK, or QNXT preferred.
  • Basic problem-solving skills.
  • Strong communication and interpersonal skills.
  • Background check required.

Privalumai

  • Annual employee bonus program.
  • Wellness program.
  • Generous paid time off.
  • Eleven paid holidays each year.
  • One floating holiday.
  • One birthday holiday.
  • 401(k) retirement savings plan with employer match and contribution.
  • Employee recognition program.
  • Tuition reimbursement.
  • Inclusive benefits.
  • Equal employment opportunity and affirmative action workplace.

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