Pennsylvania Licensed Member C&G Coordinator

Job Summary

Tracking and managing member complaints and grievances, the full-time Pennsylvania Licensed Member C&G Coordinator will ensure effective resolution and utilize data analysis to identify improvement opportunities while working remotely during daylight hours.

Key responsibilities:

• Investigate and respond to member complaints, grievances, and provider appeals in writing according to department standards
• Utilize internal and external contacts to facilitate the resolution process and ensure compliance with regulatory requirements
• Analyze trends in complaints and grievances to support improvement initiatives within the Health Plan

Required qualifications:

• Associate degree or equivalent professional work experience
• 1 year of experience in a healthcare environment
• Preferred background in medical claims and/or customer service
• Familiarity with ICD-10, HCPCS, and CPT4 coding and medical terminology
• PC literacy with proficiency in Microsoft Office products