Appeals and Grievances Representative

Your Role

The Appeals and Grievances teams receive, document, investigate, refer, and coordinates grievances, appeals and complaints. The Appeals and Grievances Coordinator will report to the Appeals and Grievances Supervisor. In this role you will be responsible for taking incoming telephone calls, reviewing, researching, and responding to incoming appeals and grievances within established compliance timeframes.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

Appeals and Grievances Representative, Intermediate

• Requires a high school diploma or GED
• Requires at least 2 years in health insurance operations such as I&B, Claims, Customer Services, Regulatory Affairs and/or Appeals/Grievances or similar combination
• Commercial/IFP/Managed Care health plan knowledge preferred

• Requires knowledge of Microsoft Systems such as Power Point, Excel, and Word

Pay Range for CA: $21.73 to $30.03

Pay Range for Bay Area: $24.50 to $34.31

Note: Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield Salaries are based on a variety of factors including the candidate experience, location (California, Bay Area, or outside California), and current employee salaries for similar roles.

Appeals and Grievances Representative, Advanced

• Requires a high school diploma of GED
• Requires at least 4 years combined health insurance operations experience such as I&B, Claims, Customer Services, Regulatory Affairs; of which at least 1 year of direct experience in Appeals and Grievances, or similar combination
• Dependability - demonstrated success in owning your case load, meeting deadlines, and/or responding timely to inquiries

• Trained in written correspondence

Pay Range for CA: $24.78 to $34.70

Pay Range for Bay Area: $27.94 to $39.12

Note: Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield Salaries are based on a variety of factors including the candidate experience, location (California, Bay Area, or outside California), and current employee salaries for similar roles.

Hybrid Virtual Work

This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.