[Hiring] Grievance Coordinator @Lumeris

Role Description

Works an important part of the Medicare Grievances Program, which is the heartbeat of Plan operations and a direct insight to member experience. Reviews and investigates member complaints and works with internal and external partners to reach mitigation and resolution for the member. Handles each grievance in accordance with organizational and regulatory guidelines.

Job Description

• Conducts thorough investigations into member complaints, identifies all issues or components of the grievance, and achieves resolution through action and education to the member. Utilizes senior resources as needed.
• Conducts rigorous root cause analysis on escalated member grievances, using structured diagnostic techniques to identify underlying system, plan, or provider issues.
• Researches, gathers information and evidence, and conducts timely outreach with members, providers, internal and external partners, reviews issues, and assesses appropriate resolution.
• Documents investigation as an accurate and complete chronological record of actions taken, communication and information obtained, and member resolution and notification for each grievance.
• Ensures grievance resolution reflects the member's complaint and accurately and completely addresses all components of the complaint. Keeps track of several cases simultaneously while making sure each member gets the attention they deserve in a high-volume, high-touch environment.
• Creates and maintains good rapport and collaborates effectively in all areas of the organization.
• Recognizes urgent and sensitive issues/incidents and escalates in a timely manner to facilitate appropriate and timely response.
• Communicates the status of assignments in weekly internal meetings for discussion and direction.
• Demonstrates sufficient knowledge of complaint and understanding of related plan processes or functions to adequately articulate issue and resolution.

Qualifications

• Bachelors degree or equivalent
• 1+ years of related work experience or the knowledge, skills, and abilities to succeed in the role
• Ability to maintain high ethical standards
• Good critical thinking and problem-solving skills
• Ability to multi-task and operate effectively in both remote and in-person settings
• Skilled problem-solver with the ability to take on basic problems and achieve a solution within a reasonable amount of time
• Good investigatory skills with ability to organize, review, and effectively assess risk and appropriate response
• Ability to remain fair and identify facts
• Organizational skills for prioritizing tasks to meet set deadlines
• Good communication and interpersonal skills with the ability to interact at all levels
• Good customer service skills

Requirements

• While performing the duties of this job, the employee works in normal office working conditions.
• Member Facing Position: Yes- Member or Patient Facing Position
• Drug Screen Requirement: No
• MVR Required: No
• Credit Check Required: No
• Location: Remote, USA
• Time Type: Full time

Benefits

• Medical, Vision and Dental Plans
• Tax-Advantage Savings Accounts (FSA & HSA)
• Life Insurance and Disability Insurance
• Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days)
• Employee Assistance Program
• 401k with company match
• Employee Resource Groups
• Employee Discount Program
• Learning and Development Opportunities
• And much more...