This Triage Coordinator will be responsible for the beginning-to-end process of receiving, reviewing, and assigning appropriate cases into the G&A system of record. This position will act as a G&A subject matter expert for all lines of business and "gate" items that do not belong in the G&A Department. This role partners with various departments to educate and work towards preventing non-G&A items from coming to the department. This is in accordance with the standards and requirements established by various Regulators. Examples include but are not limited to: DMHC, Federal and State Exchanges, CMS.

Responsibilities:

• Coordinates and manages the appropriate intake and creation of new and existing cases, while identifying the priority of each case based on an initial regulatory and case type analysis.
• Assigns each case to the appropriate team for timely and accurate processing.
• Inputs cases received within 24 hours to 2 business days and due to time sensitivity, some evening, weekend, and holiday work may be required.
• Ensures each new case has all the required elements for processing.
• Collaborates with the assigned G&A Representative or Specialist to ensure cases are acknowledged and responded to correctly, accurately, and within set service level standards.
• Performs initial analysis of case to determine escalation pathway and communications in G&A system of record.
• Categorizes grievances and appeals into appropriate classification for accurate regulatory reporting.
• Performs initial analysis and investigation through various appropriate channels and assesses for appropriate assignment of work
• Leads/coaches the G&A specialists and representatives in response to customer issues, complex inquiries, and difficult situations.
• Writes and manages outbound documents, correspondence, and reports in required time frames.

• 1+ years of experience w/High School
• Experience in customer service, provider service, health service, or dental in a managed care or health care environment handling escalated or complex issues. A minimum of 3 years experience within Grievances and Appeals.
• Knowledge of health plan benefits, processes, and operations
• Intermediate or advanced computer literacy skills
• Strong organizational, time management, and written and oral communication skills
• Detail-oriented with the ability to conduct research and identify steps required to resolve issues and follow through to completion
• Ability to be resourceful and enjoy solving complicated problems to get to the root cause

• Competitive base and incentive pay
• 401(k) with robust matching and non-matching contributions
• Rich medical & pharmacy benefits
• 100% employer-paid dental and vision benefits
• Holistic wellbeing program with deep financial incentives
• Generous paid time off plus 12 paid holidays and your birthday off
• Culture of growth and learning: career development; tuition reimbursement; recognition program
• Family support: adoption assistance, fertility treatment, child, elder & pet care assistance
• Social responsibility and volunteer opportunities
• Employee discount program