JOB SUMMARY/PURPOSEResponsible for grievance and appeals coordination and resolution for all Samaritan Health Plan (IHN, SAHP, Commercial, Choice) members who engage with the grievance process. Coordinates and resolves complaints and inquiries (included in "grievances") from regulatory agencies, consumer rights organizations and legislators. Responsible for the documentation, monitoring and regulatory reporting obligationsDEPARTMENT DESCRIPTIONSamaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services' self-funded employee health benefit plan. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services' mission of Building Healthier Communities Together.EXPERIENCE/EDUCATION/QUALIFICATIONSHigh school diploma or equivalent required. Bachelor's degree in a related field preferred.Three (3) years health plans or health insurance experience required.
Shift: Days (0830-1700) occasional weekend, ending 4/30
Specialty Type: Clerical
Sub Specialties: Patient Service Coordinator
General Certifications: N/A
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