Grievance Coordinator

» Grievance Coordinator
Legal
in Tampa
, FL
Reference: 19-03392

Description:

  • Responds to member and provider inquiries (phone, written, or walk in) regarding all aspects of our client’s business, including claims, in a professional, timely, accurate, and caring manner while consistently meeting all guidelines

Key Duties and Responsibilities:

  • Responds to member, provider, and other inquiries via telephone, correspondence or lobby walk-in while meeting all corporate guidelines and performance standards
  • Demonstrates appropriate customer-care skills such as empathy, active listening, courtesy, politeness, helpfulness and other skills as identified
  • Records, investigates and resolves member complaints as detailed in the Grievance Procedure narrative
  • Assists in the education of new members and in the re-education of existing members regarding health plan procedures
  • Track grievance case by line of business for compliance and review
  • Assist in resolving member and provider complaints
  • Makes decisions that are consistent with the concept of a win-win-win for members, associates and our client
  • Demonstrates based behaviors such as initiative, accountability and value
  • Performs skills necessary to create a high-quality customer experience, as reflected through acceptable quality audit score and productivity
  • Performs other duties as assigned

Education:

  • A High School or GED (Required)
  • An Associate’s Degree in a related field or equivalent work experience

Work Experience:

  • 1+ year of experience in a call center or customer service environment (Required)
  • 1+ year of experience in grievance experience (Preferred)
  • Experience within a health care company (Preferred)

Licenses and Certifications:

  • Customer service, quality or training certifications (Preferred)

Skills:

  • Demonstrated written communication skills
  • Demonstrated interpersonal/verbal communication skills
  • Ability to multi-task,¬†good organizational, and time management skills
  • Demonstrated organizational skills
  • Ability to effectively present information and respond to questions from families, members, and providers
  • Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
  • Ability to act on feedback provided by showing ownership of his or her own development
  • Demonstrated time management and priority setting skills
  • Ability to work as part of a team
  • Ability to read, analyzes, and interprets verbal and written instructions
  • Seeks to build trust, respect and credibility with all partners through full, honest, consistent, and coordinated communication

Technology:

  • Microsoft Outlook
  • Knowledge of email systems such as Microsoft Outlook sufficient to communicate with both internal and external contacts
  • Microsoft Excel
  • Microsoft Word Beginner
  • Healthcare Management Systems (Generic)

Level of Supervision Received:

  • Under immediate supervision, performs assigned tasks only as instructed, subject to regular check of performance