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Role Description

Facilitates the member grievance and appeal process by investigating, documenting and preparing case files to meet all regulatory requirements.

• Investigate member grievance and appeal by gathering supporting documentation from internal departments, contracted Provider Organizations (PO), and non-contracted entities as indicated.
• Communicate with the members or providers to request and gather pertinent information. Follow up as needed and document accordingly.
• Track and monitor movement of assigned cases through SCAN’s functional units and systems, to ensure compliance with designated timelines.
• Respond to requests for information from all regulatory agencies within required timeframes.
• Respond to and close cases within designated regulatory time requirements as identified by case types. Generate and send appropriate communications.
• Understand SCAN benefit structure and maintain current and additional information as it relates to Grievances and Appeals services.
• Utilize department desktop procedures, workflows, job aids and training material. Identify barriers to work processes and bring to the attention of the supervisor/manager.
• Maintain the member‘s right to privacy and protect SCAN operations by keeping information confidential.
• Adhere to all quality, compliance and regulatory standards to achieve HCS and SCAN outcomes.
• Contribute to team effort by accomplishing related results as needed.
• Actively support the achievement of SCAN’s Vision and Goals.
• Other duties as assigned.

Qualifications

• High School Diploma or equivalent experience
• 2+ years in customer service and/or grievance and appeal in healthcare setting
• Experience providing professional customer service.
• Performs work under minimal supervision.
• Handles complex issues and problems, and refers only the most complex issues to higher-level staff.
• Possesses comprehensive knowledge of subject matter.
• Provides leadership, coaching, and/or mentoring to a subordinate group.
• May act as a lead or first-level supervisor

Benefits

• Base Pay Range: $20.14 - $30.00 per hour
• Work Mode: Mostly Remote
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• 11 paid holidays per year, plus 1 additional floating holiday
• Excellent 401(k) Retirement Saving Plan with employer match
• Robust employee recognition program
• Tuition reimbursement
• An opportunity to become part of a team that makes a difference to our members and our community every day!

Company Description

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do.

Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults.

Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity.

At SCAN, we believe scale should strengthen—not dilute—our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.