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 Client 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
  • Performs 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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