Member Service Guide II

Job Summary

As a full-time remote Member Service Guide II, Complaint Resolution, the successful candidate will manage member grievances with accuracy and compassion, ensuring compliance with regulatory requirements while fostering trust and enhancing member experience.

Key responsibilities:

• Conduct thorough investigations into member grievances, identifying root causes and recommending practical solutions
• Independently resolve grievances and ensure accurate documentation across multiple systems within required timelines
• Collaborate with internal teams to gather information and improve processes related to member experience

Required qualifications:

• Experience with Medicare Advantage appeals and grievances
• Bachelor's degree or equivalent experience in healthcare or conflict resolution preferred
• Strong time management and organizational skills
• Ability to obtain and maintain access to the CMS Health Plan Management System (HPMS)
• Excellent customer service and conflict resolution skills