Grievances and Appeals (GAD) Coordinator

SCAN; Long Beach (CA); Hybrid; USD 28,000 - 40,000; Full time

Benefits offered by this job

Annual bonus

Wellness program

Paid time off

Holidays

401(k) retirement plan

Employee recognition

Tuition reimbursement

Job summary

SCAN is seeking a GAD Coordinator to coordinate a team delivering member services for Medicare Part C and D grievances. Responsibilities include ensuring enrollment verification, guiding inquiries to the right service providers, and maintaining member records.

The role emphasizes process improvement and potential involvement in member retention and renewal, with partial remote work and a strong emphasis on service excellence.

Qualifications

• 0–3 years of related experience in Grievances and Appeals for a health plan, healthcare, or managed care organization.
• Current or prior experience with Medicare Part C and D Grievances and closing out grievances is desirable.
• High school diploma or equivalent experience required.
• Comprehensive knowledge of grievances and appeals.

Responsibilities

• Coordinate the work of a team of Member Services Representatives.
• Handle Medicare Part C and D grievances and act as a closer.
• Verify member identity, membership status, and entitlement to services.
• Maintain current and accurate membership databases and records.
• Suggest new service offerings or revisions based on member feedback.
• Support member retention or renewal efforts.
• Support SCAN's Vision and Goals.
• Other duties as assigned.

Skills

Customer service

Communication

Problem solving

Leadership

Education

High school diploma or equivalent

Tools

Microsoft Office

IQMA

MHK

QNXT

Job description

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 Job

The GAD Coordinator coordinates the work of a team of Member Services Representatives that provide customer services to members and other associated individuals and groups.

This role will focus on Medicare Part C and D Grievances and will be \"closers\".

You Will

• Ensure that member inquiries are addressed and that members are referred to the appropriate service provider(s).
• Administer policies and procedures for verifying member identity, membership status, and entitlement to services.
• Maintain current and accurate membership databases and records.
• Suggest new service offerings or revisions to existing programs based on member feedback or in response to member needs or gaps in coverage.
• May participate in member retention or renewal efforts.
• We 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 Qualifications

• 0-3 years of related experience in Grievances and Appeals for a health plan, healthcare, or managed care organization.
• Current or prior experience with Medicare Part C and D Grievances and working on closing out grievances is highly desirable.
• High school diploma or equivalent experience required.
• Possesses comprehensive knowledge of subject matter (grievance and appeals).
• Customer service skills.
• Performs work under minimal supervision.
• Handles complex issues and problems, and refers only the most complex issues to higher-level staff.
• Provides leadership, coaching, and/or mentoring to a subordinate group. May act as a lead or first-level supervisor.
• Technical expertise - Basic technical skills for functional area. Advanced Microsoft Office (Word, Excel, PowerPoint, Outlook, Teams) are required. IKA, MHK, or QNXT preferred.
• Problem Solving - Basic problem solving skills.
• Communication - Good communication and interpersonal skills.

What's in it for you?

• Base salary range: $20.14 to $29.16 per hour
• Internal title: GAD Coordinator
• Work Mode: Partially Remote
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
• Excellent 401(k) Retirement Saving Plan with employer match and contribution
• 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!

Equal Opportunity Employer/Protected Veterans/Individuals With Disabilities

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.