Grievances and Appeals (GAD) Coordinator
Core
Coordinate a team of Member Services Representatives to handle member inquiries, verify identity and entitlement, and maintain membership databases for a Medicare Advantage and senior care organization.
Role type
Team lead / Coordinator for Member Services and Grievances
Builds
Member service operations and grievance/appeals processes
Domain
Healthcare / Senior Care / Medicare Advantage
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Grievance and appeals subject matter expertise, team leadership and coaching, database management, policy administration, problem solving, Microsoft Office proficiency
Preferred skills
IKA, MHK, or QNXT experience, curiosity about AI applications
Responsibilities
Ensure member inquiries are addressed and refer to appropriate providers, 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
Seniority
Mid-level, hands-on IC with team oversight