[Hiring] Member Appeals and Grievances Coordinator @Sentara Health

Role Description

Sentara Health Plans is hiring a Member Appeals and Grievances Coordinator- Remote in Virginia!

• Responsible for the investigation and documentation of member appeals and grievances in compliance with State law, applicable rules and regulations, and provider and group agreements.
• Works closely with the Plan's Medical Directors who are responsible for all decisions regarding clinical appeals/grievances.
• Collaborates with the Appeals Manager who is responsible for non-clinical appeals and grievances.

Qualifications

• HS - High School Grad or Equivalent (REQUIRED)
• Managed Care - 3 years (REQUIRED)
• Previous member appeals and grievances experience preferred

Requirements

• None required for Certification/Licensure

Benefits

• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down – $10,000
• Reimbursement for certifications and free access to complete CEUs and professional development
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria are met.