We’re looking for a Customer Service professional in the Southwest section of the Philadelphia area in a Grievance Associate role. In order to be considered for this role, you MUST have previous experience working within a Contact / Cell center in a healthcare / insurance environment.
- The Grievance Associate is responsible for ensuring all problems, complaints and grievances, presented by Plan members or their representatives are resolved in accordance with established policies and procedures as well as, NCQA and Federal/State guidelines.
- Under the supervision of the Operations Supervisor or Grievance Coordinator, the Grievance Associate acts as a member advocate and communicates with medical facility administrators, providers, physicians and all applicable AMFC departments to interpret and enhance understanding of the Plan’s policies and procedures relative to complaints and grievances.
- The Grievance Associate is responsible for accurately documenting, in the appropriate computer system, all correspondence associated with the grievance.
- The Grievance Associate will 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.
- The associate will provide Complaint/Grievance training for the Plan’s staff in the base unit and all supporting departments.
- The Grievance Associate will perform other related duties and projects as assigned.
- One to three years previous experience in direct contact with members in relation to any complaints and/or grievances
- Sound knowledge of strong telephone soft skills.
- Prior experience in highly regulated inventory
- Experience with Contact Center and Workforce Management technology (scheduling, adherence, quality monitoring)
- Minimum Degree Required: Associate’s Degree
Note: Qualified candidates will be contacted within 2 business days of application. If an applicant does not meet the above criteria, we will keep your resume on file for future opportunities and may contact you for further discussion.