Grievance and Appeals Specialist

Temporary, Full Time Grievance and Appeals Specialist

South Country Health Alliance

South Country Health Alliance is seeking a temporary Grievance and Appeals Specialist to join our team! This role is responsible for the management of assigned caseload involving member complaints received at South Country Health Alliance (SCHA), which may include member grievances or appeals. This department performs advanced and complicated case review duties requiring clinical judgment, independent analysis and detailed knowledge of departmental and regulatory procedures.

• 2 + years Health plan experience and/or experience conducting complaint investigations;
• Proficiency in Microsoft Office, especially Word and Excel
• Familiarity with medical terminology
• A knowledge of both State Public Programs (MN Medicaid) and Medicare (dual) products
• A valid, unrestricted LPN License/ RN License is preferred

South Country Health Alliance is more than a health plan—we’re a mission-driven organization dedicated to improving health and well-being in rural Minnesota communities. Our work is guided by values of communication, collaboration, stewardship, and excellence, ensuring that every employee contributes to making a real difference in people’s lives. [mnscha.org]

Join us and be part of an organization that values community impact, employee well-being, and innovation.

Temporary positions with South Country Health Alliance are not benefit eligible. This position is a hybrid position- requiring in office time in Medford, MN as organizationally necessary. This position could run up to 6 months.

Salary for this position starts at $30-$50/hour, based on qualifications and experience.

Must be legally authorized to work in the U.S. (No sponsorship available)

Position Title: Temporary Grievance & Appeals Specialist

Dept: Grievance and Appeals

Reports To: Grievance & Appeals Manager

Skill Set: Follows direction and completes assigned job tasks independently;
Performs job duties within his/her scope of practice;
Accurately categorizes requests and issues proper notices;
Demonstrates excellent written and verbal communication skills;
Ability to work cross departmentally and effectively with business partners including Third Party Administrators (TPAs), health care providers and professionals;
Ability to multi-task, prioritize assigned tasks and work effectively under pressure

Education/

Experience:

Preferred:
Current, valid, and unrestricted Minnesota LPN License and at least 2 years of health care experience. An equivalent combination of applicable education, professional training, and health care experience, which demonstrates the ability to successfully perform the responsibilities of this job, may be considered in lieu of a degree;
Proficient in Microsoft Office, especially Word and Excel;
Familiar with medical terminology. Health plan experience and/or experience conducting complaint investigations;
Associate Degree Nurse with active, unrestricted Minnesota license also preferred.

The Grievance and Appeals Department is responsible for the management of assigned caseload involving member complaints received at South Country Health Alliance (SCHA), which may include member grievances or appeals. This department performs advanced and complicated case review duties requiring clinical judgment, independent analysis and detailed knowledge of departmental and regulatory procedures.

• Processes member complaints and related requests thoroughly and completely by acquiring appropriate records and/or other information and applying problem-solving skills and investigative methodology. Cases will be processed in accordance with regulatory requirements and departmental policies and procedures, ensuring timely and proper resolution. Accurately interprets and applies policy and regulation.
• Contacts others as necessary to obtain case related information, which may involve obtaining the assistance of other SCHA staff for review/investigation of information; will collaborate effectively with others, including, but not limited to SCHA’s Chief Medical Officer and/or Medical…