QM Coordinator

Overview:

The Complaints Coordinator (CC) will assist the Chief of Regulatory & Operational Compliance (CROC) in coordinating responses to member and provider complaints in accordance with regulations and/or customer contracts. Duties include, but are not limited to, researching and responding to member and provider complaints, being able to understand fact patterns and communicate findings in an articulate, clear and concise manner. Candidate will be asked to assist with other Compliance Department duties from time to time.

• Primary job function is to triage, track, acknowledge, research and coordinate responses to member and provider complaints, appeals and grievances within the required timeframe.
• Must be proficient in the use of Microsoft Word, proper grammar, vocabulary and spelling as responses may be issued to federal and state agencies. Knowledge of Medicare Advantage & Medicaid plans a plus.
• Other duties as assigned.

• High school diploma or GED. Bachelors degree preferred.
• Effective verbal and written communication skills for varying audiences.
• Comfortable making outbound calls to providers to obtain necessary documentation to respond to complaints.
• Ability to independently research, understand and apply regulatory requirements in a corporate, dental, managed care or Medicare Advantage program is a plus.
• Proven problem-solving skills.
• Solid attendance record as this is an onsite position.
• Ability to meet deadlines and work independently.
• Preference will be given to candidates who can read, write & speak fluently in Spanish.
• Tests may be given to assess candidates ability to draft electronic communications.
  
  This is an ONSITE position in our Sugar Land office.