Appeals and Grievances Administrator Full Time

The primary purpose of the job is to: Under the general supervision of the Supervisor of Grievances, CTM and Critical Incidents, this position screens calls from members and providers regarding the Part C, Part D and Medicare-Medicaid Plan grievance processes. In addition, the Administrator will serve as a backup so when needed they will be responsible for retrieving grievances from the Customer Service database and email distribution lists and assign them appropriately to Grievance Investigators. This position will be located in our Philadelphia/South Carolina campus office and will support grievance needs of our Medicare Advantage D-SNP and MMP membership.

• Complete First Call Resolution cases, including intake, determining if case is fully resolved, generate letters and close case. If cases are not fully resolved, convert to standard grievance and assign to an investigator.
• Generating Acknowledgement Letters to mail to appellants and answering general appeal status questions.
• Assisting Investigation Specialists with grievance resolutions.
• Limited availability on weekends and holidays to monitor work queues.

Education/Experience

• High School/GED.
• Associate’s Degree preferred.
• 1 to 3 years Medicare/Medicaid experience and minimum of 2 years of experience dealing with the public.
• Medicare Advantage and MMP experience.
• Medical terminology, ICD, CPT and coding experience.
• Experience handling multiple call lines and triaging calls.

Our Comprehensive Benefits Package

Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, holidays and volunteer events, health insurance coverage for you and your dependents starting Day 1, 401(k) retirement savings plan, tuition reimbursement, and more.

Why Join Us: Your career starts now. We are looking for the next generation of healthcare leaders. At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation’s leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together, we can build healthier communities. If you are driven to make a difference, we want to hear from you.

About AmeriHealth Caritas

Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. Our services include integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at http://www.amerihealthcaritas.com