Member Appeals and Grievances Coordinator
Location
United States
Posted
7 days ago
Salary
Not specified
Job Description
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 and 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 is met.
Job Requirements
- HS - High School Grad or Equivalent (REQUIRED)
- Managed Care - 3 years (REQUIRED)
- Previous member appeals and grievances experience preferred
- 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 is met.
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