Your Role
The Blue Shield Promise Medi-Cal Appeals and Grievance team researches and resolves member/subscriber grievances, appeals, and interprets and explains health plan benefits, policies, and procedures to Medi-Cal enrollees. The Medi-Cal Appeals and Grievance Coordinator will report to the Operations Supervisor. In this role you will be responsible for producing complex written correspondence within timeliness compliance, resolving member grievances and appeals specific to mandates, and meeting Regulatory timeframes.
Your Work
In this role, you will:
- Assist with telephone inquiries regarding member appeals.
- Respond to appeals in grievances and member reconsiderations.
- Research, review, and resolve high level/high priority member grievances, appeals and complaints, while clarifying issues and educating customers in the process
- Interpret and explain health plan benefits, policies, procedures, and functions to members and providers.
- Administer ongoing grievance tracking, trending, and reporting for assigned grievances.
- Must be willing to work unplanned overtime or Saturdays as inventory demands may increase.
Your Knowledge and Experience
- Requires a high school diploma or GED
- Requires at least 2 years in health insurance operations such as I&M, Claims, Customer Services, Regulatory Affairs and/or Appeals/Grievances or similar combination
- General knowledge of applicable legislation/regulations and compliance.
- Demonstrated proficiency with free format letter writing required.
- Experience with Microsoft Office applications required.
Pay Range:
The pay range for this role is: $ 20.48 to $ 28.67 for California.
Note:
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
