Quality Complaint and Experience Resolution Specialist

3 weeks ago


Morgantown, West Virginia, United States West Virginia University Health System Full time
Quality Complaint and Experience Resolution Specialist

We are seeking a Quality Complaint and Experience Resolution Specialist to join the West Virginia University Health System team. This role will be responsible for managing the end-to-end process of complaints and grievances resolution, working closely with other members of the Peak Health Management team to ensure timely management of complaints and grievances.

The ideal candidate will have a strong understanding of federal and state laws, NCQA and industry regulations for the management of complaints, grievances, and reporting and improvement of member experience data.

Key Responsibilities:
  • Manage the end-to-end process of complaints and grievances resolution.
  • Collaborate with other members of the Peak Health Management team to ensure timely management of complaints and grievances.
  • Articulate and understand regulatory definitions and requirements within 60 days of hire.
  • Coordinate, monitor, improve, and report on the progress of cases.
  • Effectively communicate with internal and external stakeholders.

Requirements:

  • Bachelor's degree
  • One (1) year of experience working in member/patient experience or management of member/patient complaints and grievances.
  • Certification in area of expertise emphasizing ongoing commitment to continuous learning.

Preferred Qualifications:

  • At least three years of patient care experience in either a hospital or health plan setting.

Work Environment:

  • Standard office environment

Physical Requirements:

  • Demonstrated knowledge of federal and state laws, NCQA and industry regulations for the management of complaints, grievances, and reporting and improvement of member experience data.
  • Excellent written and oral communication skills.
  • Problem-solving capabilities to lead change management.
  • Attention to detail.

Salary:$43,500 - $63,000 per year, depending on experience.



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