Grievance Associate

Location: Philadelphia, PA
Date Posted: 11-26-2018
CareNational
Grievance Associate - Health Plan
Job Type:  Full Time, CONTRACT-TO-HIRE
Philadelphia, PA (South Suburb, near Chester)
 

About the Job:
 
CareNational, a leading medical management recruitment and staffing organization, is currently looking for a Grievance Associate for an expanding health plan in Philadelphia, PA.
You will be responsible for ensuring all problems, complaints and grievances, presented by health plan members or their representatives are resolved in accordance with established policies and procedures.
 
Grievance Associate Job Summary:  
  • The Grievance Associate acts as a member advocate and communicates with medical facility administrators, providers, physicians and all applicable departments to interpret and enhance understanding of the plan’s policies and procedures relative to complaints and grievances.
  • Responsible for ensuring all problems, complaints and grievances are resolved in accordance with established policies and procedures, as well as NCQA and Federal/State guidelines.
  •  The Grievance Associate is responsible for accurately documenting, in the appropriate computer system, all correspondence associated with the grievance.
  • Thoroughly research questions and issues in order to provide an accurate explanation.
  • The Grievance associate tracks and reports turnaround time and keeps abreast of all cases to ensure that the 30-day time limit for case resolution is met for 100% of all grievances.
  • Provide Complaint/Grievance training for the health plan’s staff.
     
Grievance Associate Background Profile:
 
  • 1-3 years previous experience in direct contact with members in relation to any complaints and/or grievances
  • Experience with Call Center / Contact Center and Workforce Management technology (scheduling, adherence, quality monitoring)
  • Requires at least 1 year of prior experience in manged care organization (Health Plan, TPA, etc).
  • Excellent Verbal and Written communication skills, including strong telephone "soft skills"
  • Microsoft Office skills including Word, Excel and Outlook
  • Demonstrated problem-solving and decision making skills, including experience handling escalated calls
  • Strong people skills with a focus on mentoring and coaching
  • Ability to work both independently and in a team environment
 
Grievance Associate Benefits: 
 
Position provides a comprehensive benefits plans that include Medical, Dental, and Vision. Including 401(k), PTO, Paid Holidays, and Life Insurance benefits. 
 
We are an equal opportunity employer and value diversity in our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
 
 
#ADMIN
 
ALENA MARTIN
ASSOCIATE SEARCH CONSULTANT
CareNational
alena@carenational.com
480.425.2451 (CALL – TEXT – FAX)
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