Grievances and Appeals (GAD) Coordinator

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

Benefits offered by this job

Annual Bonus program

Wellness Program

Generous PTO

11 paid holidays + floating holiday +

Birthday holiday

401(k) with employer match

Tuition reimbursement

Employee recognition program

Job summary

SCAN Health Plan is seeking a GAD Coordinator to lead a team of Member Services Representatives focused on Medicare Part C and D grievances. You will ensure inquiries are addressed, verify member identity, and refer members to appropriate service providers.

This role supports member retention, maintains accurate databases, and contributes to program enhancements based on feedback. Partial remote work, a mission-driven culture, and growth within a national nonprofit health plan are offered.

Qualifications

• 0–3 years of related experience in Grievances and Appeals for a health plan, healthcare, or managed care organization.
• Knowledge of Medicare Part C and D grievances and closing out grievances is highly desirable.
• High school diploma or equivalent required.
• Strong customer service and communication skills.

Responsibilities

• Coordinate the work of a team of Member Services Representatives.
• Ensure member inquiries are addressed and referred to appropriate service providers.
• 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 or gaps in coverage.
• Support member retention or renewal efforts as needed.

Skills

Customer service

MS Office (Advanced)

Problem solving

Communication

Leadership

Medicare knowledge

Team supervision

Education

High school diploma

Tools

IKA

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 JobThe 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 WillEnsure 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 Qualifications0-3 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 hourInternal title: GAD CoordinatorWork Mode: Partially 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)