Grievance Specialist

Job Summary

To support member advocacy, the full-time remote Grievance Specialist will manage the resolution of member grievances with accuracy and compassion, ensuring compliance with regulatory requirements while fostering trust and identifying process improvements.

Key responsibilities

• Conduct thorough investigations of grievances by reviewing case details and relevant policies
• Communicate effectively with members through written correspondence and phone calls, ensuring regulatory compliance
• Collaborate with internal partners to gather information and resolve grievances within required timelines

Required qualifications

• Experience with Medicare Advantage appeals and grievances
• Bachelor's degree or equivalent experience in healthcare or conflict resolution
• Strong attention to detail and commitment to data accuracy
• Excellent customer service and conflict resolution skills
• Ability to work independently and as part of a collaborative team