Grievances and Appeals (GAD) Coordinator
Core
Coordinate a team of Member Services Representatives to handle Medicare Advantage Part C and D Post-Service Appeals and member inquiries.
Role type
Team lead / first-level supervisor for member services and appeals
Builds
Appeals decisions and member service resolutions for Medicare Advantage plans
Domain
Healthcare / Medicare Advantage / Managed Care
Deliverable
client delivery
Required skills
Grievance and appeals process knowledge, Medicare Advantage 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
Responsibilities
Ensure member inquiries are addressed and referred appropriately; Administer policies for verifying identity, membership status, and entitlement; Maintain accurate membership databases; Suggest new service offerings based on member feedback; Provide leadership, coaching, and mentoring to subordinate representatives; Handle complex issues and refer only the most complex cases to higher-level staff
Seniority
Mid-level, hands-on IC with team leadership responsibilities