Customer Service Grievance Specialist

2 months ago

Detroit, Michigan, United States Detroit Wayne Integrated Health Network Full time

CUSTOMER SERVICE GRIEVANCE SPECIALIST

Under the general supervision of the Director of Customer Service, the Customer Service Grievance Specialist is responsible for assuring that DWIHN's grievance process is carried out in accordance with local, state, and federal regulations, BBA, Mental Health Code mandates and MDHHS contract.

PRINCIPAL DUTIES AND RESPONSIBILITIES

  • Assists with the development of grievance process and procedures in accordance with Federal Rules, MDHHS guidelines, Michigan Mental Health Code and DWIHN policies and procedures.
  • Provides applicable Customer Service information, referral, and linkage.
  • Provides oversight of telephone and walk-in-inquiries.
  • Assists with the monitoring of the grievance process at DWIHN and contractor network to ensure compliance with established policies and procedures.
  • Collaborates and coordinates with various internal/external entities to ensure that issues are addressed in accordance with mandated policies and procedures.
  • Maintains the reporting mechanism that tracks and monitors DWIHN and contractor's network complaints and grievances.
  • Assists in the review and analysis of grievance data for reporting of trends and patterns.
  • Assists in the preparation of weekly, monthly, quarterly, and annual DWIHN, ICO and MDHHS reports on grievance activity.
  • Provides technical assistance to DWIHN staff and contractors on grievance protocol and applicable dispute resolution protocols.
  • Develops and implements on-going grievance training modules specific to applicable audiences i.e., DWIHN staff, contracted providers, enrollees, and family members.
  • Assists in the development and maintenance of standardized grievance educational and informational materials (i.e. handbook, posters, forms, policies etc.).
  • Attends periodic meetings within DWIHN and/or the community to address DWIHN's issues and updates that are applicable to grievance activities.
  • Fosters a climate of collaboration and innovation to improve upon community integration and wellness outcomes among individuals who receive services.
  • Performs related duties as assigned.

* *

KNOWLEDGE, SKILLS AND ABILITIES (KSA'S):

  • Knowledge of DWIHN policies, procedures, and practices.
  • Knowledge of the DWIHN provider network and community resources.
  • Knowledge of the Michigan Mental Health Code.
  • Knowledge of MDHHS policies, rules, regulations, and procedures.
  • Knowledge of the appeals and grievance processes for behavioral health systems.
  • Knowledge of dispute resolution practices and procedures.
  • Knowledge of customer service.
  • Knowledge of compliance standards.
  • Knowledge of the Federal Confidentiality Regulations, 42 CFR, Part 2.
  • Knowledge of documents / regulations that govern the provision of mental health services, e.g., Medicaid Manual Mental Health and Substance Abuse Chapter III, State Plan for Medicaid, Michigan Department of Health and Human Services Quality Plan, BBA requirements and the Mental Health Code.
  • Knowledge of the principles, practices, and techniques of fact finding and conducting investigations.

Assessment skills.

Organizational skills.

Analytical skills.

Time Management skills.

Report writing skills.

Decision Making skills.

Customer Service skills.

Communication skills.

Active Listening skills.

Skill at meeting deadlines

Multitasking skills.

Prioritizing skills.

Written communication skills.

Accuracy and detailed oriented skills.

Investigation skills.

Training skill


  • Grievance and Appeals Coordinator

    2 months ago

    Detroit, Michigan, United States G-TECH Services, Inc. Full time

    Process appeals and grievances, analyze, research, and provide comprehensive responses in accordance with established regulatory and accreditation guidelines. Contact customers to gather information and communicate disposition of case. Conduct pertinent research in order to evaluate, respond to, and finalize case. Familiar with standard concepts, practices,...

  • Grievance and Appeals Coordinator

    1 month ago

    Detroit, Michigan, United States G-TECH Services, Inc. Full time

    The Grievance and Appeals (G&A) Coordinator is responsible for processing appeals, grievances, complaints, and inquiries received from members, authorized representatives, and regulatory agencies. The Coordinator is expected to analyze the customer's concerns, conduct necessary research by leveraging various internal and external resources and contacts in...

  • Automotive Customer Service Specialist

    1 week ago

    Detroit, Michigan, United States 696 & Gratiot Towing Llc Full time

    Join Our Team as an Automotive Customer Service Specialist at 696 & Gratiot Towing LLCWe are excited to announce an opening for an Automotive Customer Service Specialist at 696 & Gratiot Towing LLC, a reputable provider in the automotive service industry. In this role, you will be essential in ensuring customer satisfaction in a dynamic setting, addressing a...

  • Zone Bilingual Customer Service Specialist

    1 month ago

    Detroit, Michigan, United States Sherwin-Williams Full time

    Customer Service Specialists work closely with wholesale and retail customers to determine their needs, answer their questions about Sherwin-Williams products, and recommend the right solutions. Store associates Customer Service Specialists are also expected to promptly resolve any customer concerns and ensure maximum client satisfaction as well as stay...

  • Customer Service Specialist

    2 days ago

    Detroit, Michigan, United States Total Quality Logistics Full time

    About the Role:We are seeking a highly motivated and results-driven Account Representative to join our team at Total Quality Logistics. As an Account Representative, you will play a critical role in supporting our Sales Team to drive revenue growth and build strong relationships with our customers.Key Responsibilities:Communicate effectively with the sales...

  • Customer Service Representative

    5 days ago

    Detroit, Michigan, United States The Sherwin-Williams Company Full time

    About the RoleWe are seeking a highly skilled and customer-focused individual to join our team as a Bilingual Customer Service Specialist. As a key member of our sales team, you will be responsible for providing exceptional customer service, building strong relationships with wholesale and retail customers, and driving sales growth.Key...

  • Customer Service Representative

    5 days ago

    Detroit, Michigan, United States The Sherwin-Williams Company Full time

    About the RoleWe are seeking a highly skilled and customer-focused individual to join our team as a Bilingual Customer Service Specialist. As a key member of our sales team, you will be responsible for providing exceptional customer service, building strong relationships with wholesale and retail customers, and driving sales growth.Key...

  • Customer Service Representative

    5 days ago

    Detroit, Michigan, United States The Sherwin-Williams Company Full time

    Job SummaryWe are seeking a highly skilled and customer-focused individual to join our team as a Bilingual Customer Service Specialist. As a key member of our sales team, you will be responsible for providing exceptional customer service, building strong relationships with wholesale and retail customers, and driving sales growth.Key ResponsibilitiesProvide...

  • Client Services Coordinator at NSO

    1 week ago

    Detroit, Michigan, United States Neighborhood Service Organization Full time

    Job OverviewPosition: NSO Administrative SpecialistDepartment: ClinicsReporting To: NSO Administrative Specialist LeadRole Summary:The NSO Administrative Specialist plays a crucial role in delivering outstanding customer service and administrative assistance within NSO integrated clinics. This position entails overseeing a variety of responsibilities aimed...

  • Wildlife Customer Service Representative

    5 days ago

    Detroit, Michigan, United States Critter Control Full time

    Job SummaryCritter Control is seeking a highly skilled Regional Customer Service Specialist to join our team. As a key member of our customer service team, you will be responsible for providing exceptional service to our customers, resolving their issues, and ensuring their satisfaction.Key ResponsibilitiesProvide excellent customer service to our existing...

  • Customer Engagement Specialist

    1 week ago

    Detroit, Michigan, United States Midcontinent Communications Full time

    Compensation Structure: Base salary + monthly performance bonuses for promoting Midco's internet, television, and telephone services. Are you a sociable and enthusiastic person who thrives on recognition for your contributions? Midco is expanding its team and is looking for a dynamic sales professional. We provide extensive training to ensure your success....

  • Wildlife Customer Service Representative

    7 days ago

    Detroit, Michigan, United States Critter Control Full time

    Job SummaryCritter Control is seeking a highly skilled Regional Customer Service Specialist to join our team. As a key member of our customer service team, you will be responsible for providing exceptional service to our customers, resolving their issues, and ensuring their satisfaction.Key ResponsibilitiesProvide excellent customer service to our existing...

  • Customer Engagement Specialist

    1 week ago

    Detroit, Michigan, United States Midcontinent Communications Full time

    Compensation Structure: Base salary + monthly performance bonus for promoting Midco internet, TV, and telephone services. Are you a sociable and enthusiastic person who appreciates recognition for your contributions? Midco is expanding its team and is looking for a motivated sales professional. Comprehensive training will be provided. In addition to a...

  • Administrative Support Specialist for NSO

    1 week ago

    Detroit, Michigan, United States Neighborhood Service Organization Full time

    Job OverviewPosition Title: NSO Administrative SpecialistDepartment: ClinicsReporting To: NSO Administrative Specialist LeadRole Summary:The NSO Administrative Specialist plays a crucial role in delivering outstanding customer service and administrative assistance within NSO integrated clinics. This position encompasses a variety of responsibilities aimed at...

  • Field Service Specialist

    6 days ago

    Detroit, Michigan, United States NCR VOYIX Full time

    About NCR VOYIXNCR VOYIX is a leading provider of software and services in the financial, retail, and hospitality sectors. Our company is headquartered in Atlanta, Georgia, and has a global workforce of 36,000 employees. We are recognized as a leading player in these industries.Job SummaryWe are seeking a skilled Field Service Specialist to join our dynamic...

  • Customer Service and Beverage Specialist

    2 days ago

    Detroit, Michigan, United States Hollywood Casino at Greektown Full time

    Job SummaryWe are seeking a skilled and enthusiastic Bartender to join our team at Hollywood Casino at Greektown. As a Bartender, you will be responsible for providing exceptional customer service and beverage preparation in a fast-paced environment.Key ResponsibilitiesPrepare beverages in accordance with established procedures and recipes.Follow proper cash...

  • Medicare Advantage Complaint Resolution Specialist

    1 week ago

    Detroit, Michigan, United States G-TECH Services Full time

    Job OverviewWe are seeking a dedicated individual to take on the role of analyzing, investigating, and addressing complaints, appeals, and grievances from our clients and regulatory bodies.Responsibilities include crafting detailed written responses to inquiries. Each correspondence must adhere to specific elements to comply with regulatory and accreditation...

  • Service and Installation Specialist

    1 week ago

    Detroit, Michigan, United States Benco Dental Full time

    Position Title: Service and Installation SpecialistLocation: Detroit, MICompany Overview: At Benco Dental, we pride ourselves on being a family-oriented organization dedicated to advancing the field of dentistry. We are seeking a dedicated individual to join our team and contribute to our mission.What We Offer:- Competitive Compensation Packages-...

  • Mixologist and Service Specialist

    6 days ago

    Detroit, Michigan, United States DID IT MY WAY CIGAR AND WINE BAR Full time

    Job OverviewWe are seeking dedicated individuals for part-time and full-time positions as a Mixologist and Service Specialist.Key Responsibilities:As a Service Specialist:Welcome and engage guests with a warm and inviting demeanor.Accurately take and relay food and beverage orders to the kitchen and bar.Provide insightful recommendations and answer inquiries...

  • Marina Fuel Service Specialist

    5 days ago

    Detroit, Michigan, United States ABC REALTY LLC Full time

    Job OverviewABC REALTY LLC is seeking a dedicated full-time Marina Fuel Service Specialist. This role involves providing essential support to clients arriving at the fuel dock for refueling their vessels and fuel containers. The specialist is responsible for ensuring safety and efficiency during the fueling process.Key Responsibilities:Assist customers with...