The Role As a Program Assistant, you will provide essential support to the Grievance and Appeals Resolution System (GARS). Your primary focus involves managing the intake of member and provider complaints and ensuring all cases are processed according to regulatory standards.
Key Responsibilities:
- Case Management: Monitor incoming inquiries via mail, telephone, and electronic systems. Set up case files in the GARS system with accurate classifications.
- Regulatory Liaison: Act as a point of contact for inquiries from the Department of Managed Health Care (DMHC), Medicare (CMS), and the State Hearing Office.
- Administrative Coordination: Generate acknowledgment letters and gather supporting documentation from internal and external departments.
- State Hearing Support: Coordinate documentation for state hearings, including electronic filing and routing scanned documents to the local hearing office.
- Education: High school diploma or equivalent.
- Experience: One year of experience with Medi-Cal, Medicaid, Medicare programs, or appeal and grievance guidelines. An equivalent combination of education and experience will be considered.
- Technical Skills: Proficiency in Microsoft Office (Word, Excel, Outlook, PowerPoint) and the ability to navigate job-specific software.
- Communication: Ability to communicate clearly in writing and verbally. skills in Arabic, Chinese, Farsi, Korean, Spanish, or Vietnamese are preferred.
salary: $23.92 - $33.49 per hour
shift: First
work hours: 8 AM - 4 PM
education: High School
Responsibilities
5% - Program Support
- Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
- Provides support to staff, including preparing meeting materials, maintaining minutes, routing documents, conducting data entry and handling incoming and outgoing correspondence per administrative policy.
- Provides administrative support for specific and/or ongoing department projects, such as generating reports, logs, calendars and mailings while applying general business practices as well as CalOptima Health policies and procedures.
- Serves as support for the Sr Manager II’s and staff; may follow up on the progress of projects and activities.
- Coordinates work with other administrative staff and assists in coordinating staff efforts within the department.
- Maintains confidential and sensitive information and files regarding management projects, policy and personnel, ensuring appropriate follow up.
Skills
Qualifications
Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.
Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.
