Grievance Coordinator

  • location: Tampa, FL
  • type: Contract
  • salary: $16.44 per hour
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job description

Grievance Coordinator

job summary:
JOB SUMMARY

Responds to member and provider inquiries (phone. written or walk in) regarding all aspects of WellCare business. including claims. in a professional. timely. accurate and caring manner while consistently meeting all guidelines.

ESSENTIAL FUNCTIONS

Note: The following is not intended to be an exhaustive list of all duties required of this position

 
location: Tampa, Florida
job type: Contract
work hours: 8 to 5
education: High School
experience: 1 Years
 
responsibilities:
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 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.
  • Peforms other duties as assigned.
 
qualifications:
MINIMUM QUALIFICATIONS

Education

  • State the minimum required for the job
  • Education Level Education Details Required/Preferred
  • A High School or GED Required
  • An Associate's Degree in a related field Preferred---or equivalent work experience
Work Experience

  • State the minimum required for the job
  • Experience Level Experience Details Required/Preferred
  • 1+ year of experience in a call center or customer service environment Required
  • 1+ year of experience in grievance experience Preferred
  • Other Experience within a health care company Preferred
  • Licenses and Certifications
  • List professional licenses and certifications associated with this job
  • Licenses/Certifications Other Licenses/Certifications Required/Preferred
  • . Other Customer service. quality or training certifications Preferred
Skills

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

  • List technical skills associated with the job .
  • Technology Other Technology Proficiency Required/Preferred . Microsoft Outlook Knowledge of email systems such as Microsoft Outlook sufficient to communicate with both internal and external contacts Beginner Required
  • Microsoft Excel Beginner Required
  • Microsoft Word Beginner Required
  • Healthcare Management Systems (Generic) Beginner Required . Languages . List all that apply .
Languages Other Languages Required/Preferred . .

SCOPE

  • Level of Supervision Received:
  • A statement which describes the level of independence for this position. . [X] Under immediate supervision. performs assigned tasks only as instructed. subject to regular check of performance.
  • Level of Supervision Exercised:
  • (Select all that apply) Positions Supervised . [X] Individual Contributor 1 [ ] (Please check all that apply) .
Impact:

  • A statement which describes the impact to the company regarding contributions. decisions. recommendations or actions taken by the incumbent. .
  • [X] Failure to accomplish results can normally be overcome without significant effect on the organization . Problem Complexity:
  • . A statement which describes how clearly a problem is defined when presented. how much additional effort is required to understand the nature of the problem and the typical timescales for resolution.
  • . [X] Provides resolution to problems that are readily identifiable with limited scope and are resolved in accordance with standard practices. procedures. applications or routines. .
PHYSICAL DEMANDS AND WORKING CONDITIONS .

Physical Demands .

  • While performing the duties of this job. the associate is required to meet the following physical demands:
  • . The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Working Conditions .

  • While performing the duties of this job. the associate is required to meet the following working conditions:
  • Working Condition None Seldom Occasionally Frequently .
  • The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job_ Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
 
skills: Benefit Administration
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.

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