Grievances Specialist

1 week ago


San Francisco, California, United States San Francisco Health Plan Full time
Job Summary

We are seeking a highly skilled Grievances Specialist to join our team at San Francisco Health Plan. As a key member of our Clinical Grievances and Appeals team, you will play a critical role in investigating and resolving member and provider grievances and appeals.

Key Responsibilities
  • Collect, organize, and analyze data to help resolve member grievances and appeals.
  • Communicate effectively with members, providers, and other stakeholders to resolve grievances and appeals.
  • Draft and implement project plans, charters, and meeting materials to support grievance and appeal resolution.
  • Support daily operations, including research, communications, database management, meeting coordination, and event logistics.
  • Coordinate materials, record agreements, and track actions for SFHP committees and meetings.
  • Present grievance and appeals data to key stakeholders through the Grievance Review Committee (GRC) and the Grievance Program Leadership Team (GPLT).
Requirements
  • Bachelor's degree in Business, Public Health, or a related field.
  • At least one year of experience in health plan operations, healthcare clinical quality improvement, direct patient care, grievances and appeals, or a related field.
  • Experience working with EMR and Medi-Cal.
  • Familiarity with healthcare and managed care terminology.
What We Offer
  • Competitive salary range: $29.94 to $33.68 per hour.
  • Health benefits, including medical, dental, and vision coverage.
  • Retirement plans, including a CalPERS Pension and 401(a) plans.
  • Time off, including 23 days of Paid Time Off (PTO) and 13 paid holidays.
  • Professional development opportunities, including tuition reimbursement and professional license/membership.
About San Francisco Health Plan

San Francisco Health Plan is an award-winning, managed care health plan that provides affordable healthcare coverage to low and moderate-income residents in San Francisco County. We are committed to a work environment that supports, inspires, and respects all individuals and promotes diversity, equity, and inclusion.


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