The G&A Coordinator manages appeals, grievances, complaints, and inquiries from members, representatives, and regulatory agencies. This role involves analyzing concerns, conducting research using internal and external resources, and making accurate case decisions. Coordinators facilitate conferences with customers, maintain detailed documentation, and communicate resolutions through clear, compliant written correspondence. Staying current on products, networks, policies, and regulations is essential to ensure timely and accurate responses.
Key Responsibilities:
- Process appeals and grievances in accordance with established regulatory and accreditation guidelines.
- Contact customers to gather necessary information and communicate case dispositions.
- Conduct thorough research to evaluate, respond to, and finalize cases.
- Analyze and interpret data, applying contract and regulatory provisions.
- Draft clear, professional letters and documentation.
Required Education:
- High School Diploma or GED required; Bachelor’s Degree in English, Communications, or related field preferred.
Required Skills and Experience:
- Minimum 2 years of customer service experience.
- Minimum 2 years of health insurance experience, with familiarity in state and federal regulations preferred.
- Ability to manage a high workload in a fast-paced environment.
- Strong computer skills (basic navigation, saving PDFs, Excel).
- Excellent written communication and letter-writing skills.
- Analytical thinking and research capabilities.
- Ability to multi-task effectively.
Currently not accepting candidates from the following states: FL, AZ, NY, NJ, MO, MA, MD, CA.