Grievances and Appeals (GAD) Coordinator

SCAN Health Insurance; Long Beach (CA); Hybrid; USD 41,000 - 60,000; Full time

Benefits offered by this job

Annual bonus program

Wellness program

Generous PTO

11 holidays + 1 floating + 1 birthday

Job summary

SCAN Health Insurance seeks a GAD Coordinator to lead a team delivering member services and resolving grievances, with a focus on Medicare Part C and D issues. You will ensure accurate records, verify eligibility, and drive process improvements.

The role emphasizes customer service, problem solving, and collaboration with cross-functional teams, with a path toward leadership responsibilities and potential for remote work.

Qualifications

• High school diploma or equivalent experience.
• Comprehensive knowledge of grievance and appeals.
• Experience with Medicare Part C and D grievances is highly desirable.
• Strong customer service and communication skills.

Responsibilities

• Coordinate a team of Member Services Representatives.
• Close out Medicare Part C and D grievances.
• Verify member identity, status, and entitlement to services.
• Maintain accurate membership databases and records.
• Suggest improvements based on member feedback.

Skills

MS Office

Advanced Excel

Communication

Problem Solving

Customer Service

Grievances & Appeals knowledge

Medicare Part C & D

Leadership

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 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!

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.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

SCAN is proud to be an Equal Employment Opportunity and Affinity 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.

The 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)