Grievance Specialist

Job Summary

Managing member grievances and complaints, the full-time Grievance Specialist will work remotely to ensure timely and compliant resolutions across various Healthfirst product lines while advocating for members' concerns.

Key Responsibilities:

• Independently manage a caseload of grievances from acknowledgment to resolution and documentation
• Conduct detailed research and collaborate with internal departments to identify root causes and recommend solutions
• Draft and issue compliant acknowledgment and resolution letters in accordance with regulatory standards

Required Qualifications:

• HS Diploma or GED from an accredited institution
• Understanding of utilization management processes and their impact on member access to care
• Proficient in Microsoft Office Suite, including Excel, Word, PowerPoint, and case tracking systems
• 2+ years of experience in managed care, member services, or healthcare grievances resolution
• Working knowledge of Medicare Advantage, Medicaid Managed Care, and Health Insurance Exchange programs