Washington State Grievance Coordinator

Job Summary

Managing member and provider complaints, the full-time remote Washington State Grievance Coordinator will coordinate and resolve grievances and appeals while ensuring compliance with regulatory requirements and organizational policies.

Key responsibilities

• Provide guidance and support for grievance and appeals processes to providers
• Conduct thorough investigations and document all actions taken to resolve grievances and appeals
• Ensure compliance with state and federal regulations, NCQA guidelines, and Plan policies in processing grievances and appeals

Required qualifications

• High School Diploma or equivalent combination of education and experience
• Minimum of one year operational experience in a managed health care environment
• Experience with Medicaid and Medicare programs
• Prior experience in grievance/appeal resolution
• Knowledge of medical terminology and related coursework (preferred)