[Hiring] Member Appeals and Grievances Coordinator @WellSense Health Plan

Role Description

The Member Appeals and Grievances (A&G) Coordinator performs administrative functions associated with incoming Member Appeals and Grievances. The A&G Coordinator is responsible for:

• Identification, intake, and distribution of member appeals and grievances.
• Maintaining organized, secure, and efficient record-keeping processes.
• Responding to other business areas and members/providers regarding the status of appeals and grievances or A&G processes in a timely and professional manner.
• Establishing and maintaining collaborative and meaningful interdepartmental relationships.

Qualifications

• Bachelor’s degree in Health Care Administration, related field, or an equivalent combination of education, training, and experience is required.
• Experience with Microsoft Office Applications.
• Demonstrated ability to use proprietary healthcare management system(s).
• Proven ability to identify problems and procedural irregularities, collect data, establish facts, and draw valid conclusions.
• Experience preferred with:
  • JIVA
  • Facets
  • Express Scripts, Inc
  • HPMS
  • Access
  • 2 or more years of experience in a healthcare setting, specifically related to Appeals and Grievances.
  • Experience with data entry, trend analysis, and reporting.
  • Experience with health insurance (Commercial, Medicaid, and Medicare).
  • Experience with rules and regulations governing health insurance (Commercial, Medicaid, and Medicare).
  • Experience communicating with a provider network.
  • Certified Professional Coder (CPC) certification.

Requirements

• Pre-employment background check.

Benefits

• Full-time remote work.
• Competitive salaries.
• Excellent benefits.
• Generous total compensation that includes:
  • Medical, dental, vision, pharmacy benefits.
  • Merit increases.
  • Flexible Spending Accounts.
  • 403(b) savings matches.
  • Paid time off.
  • Career advancement opportunities.
  • Resources to support employee and family wellbeing.

Working Conditions and Physical Effort

• Regular and reliable attendance is an essential function of the position.
• Flexibility to work some evening/weekend hours if necessary.
• Work is normally performed in a typical interior/office work environment.
• No or very limited physical effort required.
• No or very limited exposure to physical risk.

Compensation Range

$20.19 - $28.13. This range offers an estimate based on the minimum job qualifications. Our approach to determining base pay is comprehensive, considering factors such as education, experience, skills, and certifications/licensure as they relate to position requirements, as well as business/organizational needs, internal equity, and market competitiveness. Note: This range is based on Boston-area data and is subject to modification based on geographic location.