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Grievance Resolution Specialist

2 months ago

Orange, California, United States Infojini Inc Full time
Job Title: Grievance Specialist

At Infojini Inc, we are seeking a highly skilled and detail-oriented Grievance Specialist to join our team. As a Grievance Specialist, you will play a critical role in ensuring that our members receive timely and fair resolution of their grievances and appeals.

Key Responsibilities:
  • Program Support: Participate in a mission-driven culture of high-quality performance, with a focus on customer service, consistency, dignity, and accountability.
  • Data Management: Maintain accurate and up-to-date information in our systems, ensuring data collection, summarization, integration, and reporting.
  • Grievance and Appeals: Gather relevant information regarding grievances and appeals, including member or provider concerns, supporting information, and new information.
  • Case Discussions: Coordinate and participate in case discussions with operational experts to result in a final case disposition.
  • Communication: Develop resolution letters and correspondence to members and providers, and communicate with internal and external customers to ensure timely review and resolution of grievances or appeals.
Qualifications:
  • Education: High School diploma or equivalent required.
  • Experience: 1 year of experience in Grievances and Appeals, Claims, Regulatory Compliance, Customer Service, or a related field required.

We offer a dynamic and supportive work environment, with opportunities for growth and development. If you are a motivated and detail-oriented individual with excellent communication skills, we encourage you to apply for this exciting opportunity.