Grievances and Appeals (GAD) Coordinator
Core
Coordinate a team of Member Services Representatives handling Part C and D Pre-Service Appeals intake for older adults.
Role type
Team lead / Coordinator for Member Services Appeals
Builds
Appeals intake processes and member service workflows
Domain
Healthcare / Medicare Advantage / Senior Care
Deliverable
client delivery
Required skills
Grievances and Appeals knowledge, Part C and D Pre-Service Appeals intake, membership database management, policy administration, leadership and mentoring, problem solving, Microsoft Office (Word, Excel, PowerPoint, Outlook, Teams)
Preferred skills
IKA, MHK, or QNXT experience
Responsibilities
Ensure member inquiries are addressed and referred appropriately, verify member identity and entitlement, maintain membership databases, suggest program revisions based on feedback, support member retention, provide leadership and coaching to subordinates
Seniority
Mid-level, hands-on IC with team leadership