Complaints Specialist

Who We Are

At Lucet, we are industry leaders in behavioral health, dedicated to helping people live healthy, balanced lives. Our purpose is to advocate for and improve the overall well-being of those we serve, through balanced treatment of the mind and body.

When you join Lucet, you become a valued member of our team, serving more than 15 million people across the U.S. Our employees have a passion for helping others - and it shows. From entry-level employees to senior leaders, we are inspired by our members, putting them first in everything we do. From day one, you'll see firsthand the impact you have on our members, knowing you can make a true difference in their lives.

Why join our team at Lucet?

We are a team of collaborative and hard-working professionals working to improve behavioral health outcomes working in a fast-paced and changing environment. At Lucet, no two days are the same. If you find joy in meaningful work and delivering excellent results, we encourage you to apply

We are looking for top-tier skills and experience in our remote-work environment and that's because we offer top-tier compensation and benefits, which include:

• Annual compensation between $60,000 - $75,000, PLUS an annual performance-based, discretionary incentive. Compensation is dependent on non-discriminatory factors including but not limited to an applicant's skills, education/degrees, certifications, prior experience, market data, and other relevant factors.
• Full Health Benefits – Medical, Dental, and Vision
• 401(k) with competitive employer match
• Company paid life and disability insurance, wellbeing incentives, and parental leave
• Professional development opportunities and tuition reimbursement
• Paid time off including paid time off for volunteering
• Opportunity for meaningful growth, both personally and professionally, where your unique background and experience is welcomed and valued.

What You Will Do - Essential Functions

The Spec, Complaints processes quality-of-care complaints, grievances, and incidents. Duties include all aspects of clinical quality of care complaint and incident investigations including documentation, interviews, obtaining responses from providers or facilities, reviewing medical records, staffing findings with the medical director, and resolution processes. This position requires knowledge of standards of care, identification of trends and include audit activity of medical records. The CQS is responsible for clearly written reports, and monitoring compliance.

• Complaint Investigation and Resolution: Manages the full lifecycle of complaints, grievances, and incidents, including documentation, investigation, and timely resolution. Reviews medical records and applies clinical and regulatory standards to assess quality-of-care issues. Communicates findings to management and ensures confidentiality throughout the process.
• Data Analysis, Reporting, and Performance Improvement: Collects and analyzes data for complaints, incidents, and audits using statistical methods. Prepares clear, detailed reports for internal teams, external auditors, providers, and senior leadership. Participates in performance improvement initiatives, applying methodologies and tools to drive change and address gaps.
• Accreditation, Compliance, and Cross-Functional Collaboration: Supports accreditation preparation and coordinates projects across departments to meet standards. Ensures compliance with federal, state, and organizational policies regarding privacy and security. Engages in multidisciplinary workgroups and committees to promote quality and continuous improvement.

Who You Are

• Required Qualifications
• • Unencumbered license to practice independently in a behavioral health related field or a BSN/RN.
• 3+ years post licensure behavioral health with facility-based and/or outpatient behavioral health or chemical dependency treatment OR healthcare experience with in-home primary or longitudinal care.
• 1+ year of experience working with quality management principles, study design, data analysis, and report preparation.
• 1+ years of experience in medical record review, interpreting medical or behavioral cases with a cognitive understanding of evidence- based standards and medical practice.
• Intermediate skills with Microsoft Office (Word, Excel, Power Point and Outlook) and Visio.
• Someone who embodies our values by:
• • Serving everyone with compassion and leading with empathy.
• Stepping up and creating value by taking charge and acting when there is an opportunity.
• Adapting in a changing world by recognizing our responsibility to be agile and respond quickly.
• Nurturing growth and belonging by respecting and celebrating everyone for who they are.
• Competencies
• • Critical thinking and analytical skills; able to decipher best practice research with statistical discrimination, design audits and surveys.
• Strong written communication skills including routine ability to compose correspondence, memos, and reports, with text tables and graphics as required.
• Flexibility and ability to multi-task
• Highly organized and detail-oriented
• Adaptable to various software programs
• Actively participate in and positively contribute to team processes and lead team activities
• Problem Solving
• Working Conditions:
• • Work is performed indoors in a remote, home setting or typical office environment - not substantially exposed to adverse environmental conditions.
• Since this is a remote position, employees must have a dedicated private workspace in their home to ensure productivity, confidentiality, and professionalism.
• Frequent exposure to VDT screens, video calling, headphones, and computers.
• Physical demands include constant ability to remain in a stationary position, move about inside an office or remote setting, able to communicate and exchange information with others, able to inspect information, and able to perform repetitive motion with arms and fingers.
• Mental demands include constant ability to interpret data, problem solve, make decisions, and organize and plan.

We encourage applicants with a range of experiences who can demonstrate how their qualifications and skills align with the requirements of this role.

This position will accept and review new applications and resumes no less than 5 business days after the original posting date and may remain open an extended period of time with no set end date based on the level of interest.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.