*Please note that the Triage Coordinator role is a hybrid position that requires the employee to come into the office as needed and live within a reasonable distance of our Camp Hill, PA office.

The Triage Coordinator is responsible for managing the end-to-end process of receiving, reviewing, and assigning cases in the Grievance and Appeals (G&A) system of record. As a subject matter expert in G&A, this role ensures that only relevant items are processed by the G&A department while preventing non-G&A items from entering the workflow. The Triage Coordinator will collaborate with various departments to educate and enforce these standards, which align with requirements established by regulatory bodies, including Department of Managed Health Care (DMHC), Federal and State Exchanges, and Centers for Medicare and Medicaid Services (CMS).

• Case Management: Coordinate and manage the intake and creation of new and existing cases, identifying the priority of each case based on initial regulatory and case type analysis.
• Assignment: Assign cases to the appropriate team for timely and accurate processing.
• Data Entry: Input cases within 24 hours to 2 business days; due to time sensitivity, some evening, weekend, and holiday work may be required.
• Quality Assurance: Ensure each case has all required elements for accurate processing.
• Collaboration: Work closely with G&A Representatives and Specialists to ensure cases are acknowledged and responded to correctly, accurately, and within established service level standards.
• Analysis: Perform initial analysis to determine the escalation pathway and communications in the G&A system of record.
• Classification: Categorize grievances and appeals accurately for regulatory reporting.
• Investigation: Conduct initial analysis and investigation through appropriate channels to assign work correctly.
• Leadership: Lead and coach G&A Specialists and Representatives in handling customer issues, complex inquiries, and difficult situations.
• Documentation: Write and manage outbound documents, correspondence, and reports within required time frames.

• Experience: Minimum of 1 year with a High School diploma. At least 3 years of experience within Grievances and Appeals in a managed care or healthcare environment, handling escalated or complex issues.
• Knowledge: Familiarity with health plan benefits, processes, and operations.
• Skills: Intermediate to advanced computer literacy. Strong organizational, time management, and communication skills, both written and oral.
• Attention to Detail: Ability to conduct research, identify steps required to resolve issues, and follow through to completion.
• Problem-Solving: Resourceful and adept at solving complicated problems to identify and address root causes.

• 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