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The Grievance & Appeals Coordinator I analyzes and resolves verbal and written claims and authorization appeals from providers, manages member and provider complaints, maintains files on appeals, coordinates grievance committees, supports pay-for-performance programs, and assists with HEDIS production functions.

The Escalation Response Specialist III is responsible for managing and resolving escalated complaints from members and providers. This role involves documenting issues, identifying trends, coordinating with various departments to facilitate issue resolution, and providing updates to stakeholders to enhance the customer experience.

The Regional Agency Manager is responsible for achieving annual sales goals related to the Medicare book of business, engaging with community organizations and brokers, responding to escalated issues, conducting training, and developing best practices based on market conditions. The position requires significant travel and building strong relationships internally and externally.