Grievance and Appeals Coordinator

Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general caregivers with the guidance and plans they need for healthy living.

JOB SUMMARY:

As an integral part of the Grievance and Appeals (G&A) Department, the G&A Coordinator lends their support in processing member-related grievances and appeals across CPHL’s various lines of business. Process includes gathering, documenting, tracking, and pursuing resolution of complaints in accordance with regulatory and organizational guidelines to the member’s satisfaction.

PRIMARY RESPONSIBILITIES: 

• Logs and tracks verbal or written member grievances and appeals.
• Conducts relevant research into complaints and collaborates, coordinates and communicates with various departments (i.e. Member Services, Care Management, Claims), as well as external entities (i.e. Providers and Vendors) to collect additional information as necessary.
• Maintains a current knowledge of plan products, policies and procedures with the ability to relate acquired knowledge in a clear, concise and understandable manner to members, providers, and internal staff.  
• Ensures grievances and appeals are handled and resolved in compliance with timeliness requirements, and at the highest standards for accuracy.
• Prepares, generates, and mails letters, forms, and other G&A-related notices.
• Maintains confidentiality of all protected health information in accordance with state, federal, and corporate guidelines.
• Performs other duties as assigned

Qualifications:

Education

High school diploma or equivalent required. Associate’s Degree preferred

Experience

Minimum two years of experience in customer service or health service environment. Previous experience in Managed Care grievances/appeals preferred. Strong communication, organizational, critical thinking, and problem solving skills.                                          

Centers Plan For Healthy Living is committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our employees and our business. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law and will not be denied employment.