Appeals and Grievances Representative, Intermediate (Medi-Cal)

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 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.
• Experience with Microsoft Office applications required.