Grievance Resolution Specialist

2 weeks ago


Honolulu, Hawaii, United States AlohaCare Full time
Job Summary

AlohaCare is seeking a highly skilled Grievance Coordinator to join our Appeals and Grievances team. As a key member of our team, you will be responsible for ensuring timely and compliant resolution of member and provider grievances and appeals.

Key Responsibilities
  • Review and research complaints, grievances, and appeals to ensure accurate and timely resolution.
  • Coordinate with internal teams to ensure compliance with regulatory requirements and internal policies.
  • Prepare and communicate written decisions to members and providers in a clear and concise manner.
  • Maintain accurate records and logs of grievances and appeals, including tracking dispositions and timeliness of resolution.
  • Participate in internal committee and interdisciplinary meetings to discuss recent activity and trends, and make recommendations for problem resolution and performance improvement.
Requirements
  • Associate's degree or equivalent combination of education and experience.
  • 1-2 years of related work experience in healthcare or a related field.
  • Excellent verbal and written communication skills, with the ability to communicate complex information in a clear and concise manner.
  • Strong analytical and problem-solving skills, with the ability to work in a fast-paced environment.
  • Ability to multitask and prioritize multiple projects and deadlines.
  • Experience with utilizing multiple databases and software systems.
Preferred Qualifications
  • Bachelor's degree in a related field.
  • Knowledge of Medicaid, Hawaii QUEST Integration Program, and/or Medicare.
  • Experience with grievance and appeal processing.
Physical Demands/Working Conditions
  • Inside working conditions.
  • No environmental hazards.
  • Ability to conduct training and potentially use audiovisual presentations.
  • Sedentary work, exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects.
Salary Range

$22.75 an hour.

AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans' status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.



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