Grievance Coordinator Lead

1 day ago

Diamond Bar, California, United States Call the Car Full time
Job Title: Lead Grievance Coordinator

Job Summary:

The Lead Grievance Coordinator is responsible for assisting the Grievance Management team in ensuring daily tasks and responsibilities are completed by Grievance Coordinators. This role provides training for the team and monitors the productivity of Lead Grievance Coordinators.

Key Responsibilities:

  • Review all systems throughout the day to ensure all cases are captured and assigned appropriately.
  • Reviews completed complaints/grievances and any incident, accident, and injuries reported.
  • Provides tools and training to address any gaps in knowledge, competency, and skills to Quality staff.
  • Assist Grievance personnel in documenting, filing, tracking, and closing grievances.
  • Ensure Grievance staff maintains compliance with all Department timeframes, documentation, and process per Call the Car (CTC) policy.
  • Assist CTC management in the assessment of grievance information for potential changes to CTC policies and procedures.
  • Creating and/or updating any Grievance Desk Level Procedures that are needed.
  • Completes quality review on all resolution letters and correspondence to members, providers and/or vendors for accuracy, quality, and proper documentation.
  • Ensure appropriate grievance acknowledgement, resolution, and appeal letters are sent out within regulatory compliance and internal guidelines.
  • Ensure grievance summaries and Corrective Action Plans (CAPs) are sent to contracted vendors and internal departments if needed and ensures that all CAPs are addressed.
  • Identifies trends and root cause of issues, propose solutions, or escalates ongoing issues to Quality Management team.
  • Required to complete or process grievances/complaints of a complex nature or whenever assistance is needed.
  • Monitors the entering of all grievances the same day received for each assigned day.
  • Monitors the management of group email inboxes to ensure cases received are entered into the system correctly and in a timely manner.
  • Monitors the researching, documenting, and closing of complaints and grievances.
  • Researches and responds to any rebuttals including but not limited to vendor, client, or member of substantiated grievances and/or complaints.
  • Measure and review daily productivity for Grievance Coordinators.
  • Provides training and onboarding orientation for new and/or existing Grievance staff.
  • Ensure all grievances/complaints are closed in the system daily.
  • Any other duties as assigned by management.

Requirements:

  • 2+ years of relevant working experience in a medical environment.
  • 1-1.5 years of call center experience in a customer service setting preferred.
  • 2+ years of experience with complaints and/or grievance resolution in a medical environment.
  • Minimum high school diploma or GED required.
  • Proficiency with Microsoft Office (Word, Excel, PowerPoint, Outlook) required.
  • Skilled using Google Docs and Drive, SharePoint, and Smartsheet preferred.
  • Excellent problem-solving, organization, multi-tasking, and time management skills.
  • Effective written and verbal communication skills.
  • Must pass a Criminal Background Screening and a Drug Screen.
  • Must pass government exclusion list at time of hire and monthly thereafter.
  • Must be Bilingual Spanish/English.

Accommodation: Call the Car has the right to modify the duties and functions of the job description based on the needs of the organization.

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