Grievances and Appeals (GAD) Coordinator
Core
Coordinate a team of Member Services Representatives handling Medicare Advantage Part C and D Post-Service Appeals and member inquiries.
Role type
Team lead / first-level supervisor for member services
Builds
Member service operations and appeals processes
Domain
Healthcare / Medicare Advantage
Required skills
Grievance and appeals knowledge, Medicare Advantage Part C and D expertise, team leadership, database management, policy administration, complex problem solving, 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 membership databases, suggest program revisions based on feedback, provide leadership and mentoring to subordinates, handle complex issues
Seniority
Mid-level, hands-on IC with team leadership