Regulatory Complaint Coordinator, Intermediate-CalPERS
7 days ago
Your Role
The CalPERS team within the Appeals and Grievance Department is responsible for processing and responding to Appeals and Grievances as well as inquiries received directly from CalPERS members, regulatory agencies and CalPERS directly. The Regulatory Complaint Coordinator, Intermediate, will report to the CalPERS Supervisor. In this role you will perform comprehensive research related to the facts and circumstances of member complaints, appeals, and grievances. You will also be responsible for effectively managing your time daily to ensure you are meeting and/or exceeding compliance, quality, and production metrics.
Your Work
In this role, you will:
* Prepare detailed file summary responses for submission to multiple regulatory, legislative, and accreditation agencies.
* Be involved in evaluating and researching end-to-end timelines of member health provider services, claim processing, and other data to determine decision and/or alternative ways to resolve grievance/appeal.
* Respond to the most complex and highest financial and/or goodwill impact regulatory complaint inquiries.
* Research the data files and develop a timeline of events and gather missing information from third parties such as medical providers, to determine the response to the inquiry.
* Respond to correspondence addressed to highest level executives regarding issues and/or concerns that an individual (member or non-member) may have.
* Respond to all CalPERS Request for Health Plan Information (RHPI) requests according to timeliness requirements.
* Communicate actively with Leadership, other departments, regulatory agencies, etc. to resolve issues relating to CalPERS appeals and grievance processing
* Other responsibilities/duties as assigned
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El Dorado Hills, United States Blue Cross and Blue Shield Association Full timeYour RoleThe CalPERS team within the Appeals and Grievance Department is responsible for processing and responding to Appeals and Grievances as well as inquiries received directly from CalPERS members, regulatory agencies and CalPERS directly. The Regulatory Complaint Coordinator, Intermediate, will report to the CalPERS Supervisor. In this role you will...
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El Dorado Hills, United States Blue Shield of California Full timeThe Cal. PERS team within the Appeals and Grievance Department is responsible for processing and responding to Appeals and Grievances as well as inquiries received directly from Cal. PERS members, regulatory agencies and Cal. PERS directly. The Regul Regulatory, Media, Coordinator, Processing, Insurance, Business Services
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El Dorado Hills, United States Blue Shield of California Full timeThe Cal. PERS team within the Appeals and Grievance Department is responsible for processing and responding to Appeals and Grievances as well as inquiries received directly from Cal. PERS members, regulatory agencies and Cal. PERS directly. The Regul Regulatory, Media, Coordinator, Processing, Insurance, Business Services Learn More
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