Grievances and Appeals (GAD) Coordinator
Core
Coordinate a team of Member Services Representatives to handle Medicare Part C and D grievances and appeals, acting as a 'closer' for these cases.
Role type
Senior IC Grievances and Appeals Coordinator (Team Lead)
Builds
Medicare Advantage and Part D grievance resolution workflows
Domain
Healthcare / Medicare / Managed Care
Deliverable
client delivery
Required skills
Grievance and appeals process knowledge, Medicare Part C and D expertise, team leadership and coaching, database management, policy administration, complex issue resolution, Microsoft Office proficiency
Preferred skills
IKA, MHK, or QNXT system experience, AI curiosity
Responsibilities
Ensure member inquiries are addressed and referred appropriately; administer policies for verifying identity and entitlement; maintain accurate membership databases; suggest new service offerings based on member feedback; provide leadership and mentoring to subordinate representatives; close out Medicare grievances
Seniority
Senior, hands-on IC with team leadership