What are the responsibilities and job description for the Appeals and Grievances Intake Representative position at Summa Health?
SummaCare - 1200 E Market St, Akron, OH
Full-Time / 40 Hours / Days
SummaCare is a Summa Health entity that offers health insurance in northern Ohio. As a regional, provider-owned health plan, SummaCare is based in Akron, Ohio, and provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2025 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits.
Summary :
Creates and prepares grievance and appeal (G&A) files for investigation. Ensures Member and provider G&A communications are delivered on time, per CMS regulations, via written letter, email, telephone call and fax. Informs Members and Providers that call the Appeals and Grievance Department by relaying timeframes, Plan decisions and other information specific to the Plan’s processing of Appeals and Grievance work.Formal Education Required :
a. High School Diploma or equivalent.
Experience & Training Required :
a. Two (2) years increasingly responsible clerical/secretarial experience.
b. Claims processing or Member / Customer Service / Patient Care experience in a healthcare environment preferred.
Other Skills, Competencies and Qualifications:
a. Ability to learn and maintain current understanding of various benefit packages, including basic knowledge of claims processes and systems.
b. Communicate effectively with others through written and verbal means.
c. Ability to apply appropriate rules of grammar, usage, and style when preparing correspondence and documentation.
d. Demonstrate proficiency in Microsoft Office applications requirements to complete job functions (e.g. Word and Excel).
e. Ability to learn and maintain current knowledge of and comply with regulatory and company policies & procedures.
f. Represents SummaCare in a professional demeanor with warm, non-confrontational customer-first attitude. Project empathy, confidence, and service-oriented attitude.
g. Ability to organize and manage time to accurately complete tasks within designated time frames in fast paced environment.
h. Ability to maintain confidentiality of patient and business information.
i. Flexible: ability to adjust work hours to meet business demands.
Level of Physical Demands:
a. Sit and/or stand for prolonged periods of time.
b. Bend, stoop, and stretch.
c. Lift up to 20 pounds.
d. Manual dexterity to operate computer, phone, and standard office machines.
Equal Opportunity Employer/Veterans/Disabled
$18.13/hr - $21.75/hr
The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical.
Salary : $18 - $22
