Customer Solution Center Appeals and Grievances Training Specialist II
3 weeks ago
Customer Solution Center Appeals and Grievances Training Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 9802 Salary Range: $77,265.00 (Min.) - $100,445.00 (Mid.) - $123,625.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Customer Solutions Center Appeals and Grievances (A&G) Training Specialist II is primarily responsible for the overall training strategy across the department. This position designs and conducts training programs using established regulatory and departmental guidelines. This position is responsible for providing ongoing training on the core processing system, A&G processing procedures, training regulatory changes which will affect established procedures, working with the quality team on quality and performance guidelines, creating and maintaining departmental policy and procedures. Additional responsibilities include evaluating initial training and ongoing learning opportunities to achieve consistency, efficiency, and productivity among the staff. Duties Applies knowledge and skills to build competencies for the design of training programs that will boost employee’s workplace performance in alliance with Enterprise and departmental goals. Responsible for performing training needs assessments with the department management and will leads the design and delivery of curriculum and learning materials to ensure the success of new and current staff. Conducts training for Customer Solution Center A&G team in customer service, product operations, and other work processes. Conducts training sessions covering specified areas such as on-the-job training, use of computers and software, interpersonal skills, quality & process issues, and product knowledge. Maintain documentation, including database/system updates, training agendas, sign-in sheets, etc. to demonstrate trainee compliance with department requirements. Work with key stakeholders to monitor error trends, productivity, and quality standards for the program. Identifies gaps in knowledge, skills and abilities, assess and recommend training/education measures to resolve issues and enhance staff performance. Propose program modifications to enhance performance and positively influence member satisfaction survey results. Conduct assessments after training to measure, record, and report feedback on training material and sessions. Serve as coach staff to handle problems and concerns as they arise. Review and recommends updates on policy and procedure critical to claims process. Perform other duties as assigned. Duties Continued Education Required Bachelor's Degree in Business Administration or Healthcare Related Field In lieu of degree, equivalent education and/or experience may be considered. Education Preferred Experience Required: A minimum of 3-5 years of Managed Care, Medicaid, Medicare experience required. A minimum of 3-5 experience in design and delivery (facilitating and coordinating) of training programs. Skills Required: Strong understanding of learning principles and ability to demonstrate in classroom (or virtual classroom) situations. Knowledge of CA regulatory guidelines, Medi-Cal guidelines, Medicare guidelines, NCQA requirements. Skilled in group facilitation and managing effective discussion and dialogue to enhance the learning experience. Strong organizational & analytical skills. Ability to conduct effective and engaging presentations in a variety of delivery settings. Ability to interpret technical data, processes, operating and maintenance instructions and procedure manuals. Must be a strong team player willing to work toward achieving team goals. Must be flexible to meet the changing training needs. Professional demeanor. Commitment to Team Culture. Excellent written and verbal communications skills. Proficient using Word, Excel, Power Point and Access. Licenses/Certifications Required Licenses/Certifications Preferred Required Training Physical Requirements Light Additional Information Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. L.A. Care offers a wide range of benefits including Paid Time Off (PTO) Tuition Reimbursement Retirement Plans Medical, Dental and Vision Wellness Program Volunteer Time Off (VTO)
-
Los Angeles, United States L.A. Care Health Plan Full timeThe Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and provider complaints and appeals exercising strong independent judgment. This position will provide resolution of complaints in co Solution, Appeals, Specialist, Customer, Technology, Healthcare
-
Los Angeles, United States CCG Business Solutions, LLC Full timeCustomer Solutions Center Appeals and Grievances (A&G) Training Specialist II - Los Angeles, CA, USA - Full-time **Company Description** CCG Talent Management is not only a business solutions company but a company that believes success starts with the individual. CCG Business Solutions has been consulting and providing talent placement services since 2007....
-
Los Angeles, United States Med4Hire Full time**Customer Solution Center Appeal and Grievance Compliance Advisor** **Hybrid** **Position will be hybrid - during audits that are conducted in the year will come on site to collaborate with team. Person must be flexible and ideally live local to Los Angeles. Person must be living in state while working remote.** **Los Angeles, CA,...
-
Los Angeles, United States BI-Commercial Full timeJob DescriptionJob DescriptionTitle - Customer Solution Center Appeals and Grievances Training Specialist IIJob Type - Hybrid | Permanent Location - Los Angeles, CA (Position will be Hybrid - will be conducting combination WebEx and in near future Onsite Trainings. Person must be flexible. Person will need to be working in state remote when working from...
-
Los Angeles, United States L.A. Care Health Plan Full timeCustomer Solution Center Appeals and Grievances Nurse Specialist RN II **Job Category**:Clinical**Department**:CSC Appeals & Grievances**Location**:Los Angeles, CA, US, 90017**Position Type**:Full Time**Requisition ID**:10889**Salary Range**: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)- Established in 1997, L.A. Care Health Plan is an...
-
Los Angeles, United States L.A. Care Health Plan Full timeCustomer Solution Center Appeals and Grievances Nurse Specialist RN II **Job Category**:Clinical**Department**:CSC Appeals & Grievances**Location**:Los Angeles, CA, US, 90017**Position Type**:Full Time**Requisition ID**:10886**Salary Range**: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)- Established in 1997, L.A. Care Health Plan is an...
-
Customer Solution Center Appeal
4 days ago
Los Angeles, United States CCG Business Solutions, LLC Full timeCustomer Solution Center Appeal and Grievance Compliance Advisor - Los Angeles, CA, USA - Full-time **Company Description** CCG Talent Management is not only a business solutions company but a company that believes success starts with the individual. CCG Business Solutions has been consulting and providing talent placement services since 2007. Our team...
-
Los Angeles, United States Bryant Staffing Solutions Full time**Title:**:Customer Solutions Center A&G Training Specialist II **Status**: Full-Time, Hybrid **Location:**:Los Angeles, California **Salary**: $77,265 - $100,445 **Bonus**: 4% incentive bonus and merit increase yearly **Sponsorship**: No visa sponsorships are supported **_ **Position will be Hybrid - will be conducting combination WebEx and in near...
-
Los Angeles, United States Health Career Associates Full timeCustomer Solution Center Appeals and Grievances Training SpecialistPosition will be Hybrid - will be conducting combination WebEx and in near future Onsite Trainings. Person must be flexible. Person will need to be working in state remote when working from home.Job SummaryThe Customer Solutions Center Appeals and Grievances (A&G) Training Specialist II is...
-
Appeals and Grievances Training Specialist
4 days ago
Los Angeles, United States Business Integra Inc Full timeTitle - Customer Solution Center Appeals and Grievances Training Specialist II Job Type - Hybrid | Permanent Location - Los Angeles, CA (Position will be Hybrid - will be conducting combination WebEx and in near future Onsite Trainings. Person must be flexible. Person will need to be working in state remote when working from home). Required: Must have 3...
-
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $67,186.00 (Min.) - $87,342.00 (Mid.) - $107,498.00 (Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in...
-
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $67, Min.) - $87, Mid.) - $107, Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $67, Min.) - $87, Mid.) - $107, Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $67,186.00 (Min.) - $87,342.00 (Mid.) - $107,498.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million...
-
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $67,186.00 (Min.) - $87,342.00 (Mid.) - $107,498.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million...
-
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $67, Min.) - $87, Mid.) - $107, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $67, Min.) - $87, Mid.) - $107, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $60,778.00 (Min.) - $75,950.00 (Mid.) - $91,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million...
-
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $60, Min.) - $75, Mid.) - $91, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Los Angeles, United States Syntricate Technologies Full timeThe Customer Solution Center Audit Readiness Specialist II is responsible for the execution, oversight, and monitoring of the guidelines and protocols to ensure readiness for all regulatory audits. This position will develop, with the assistance of CSC management, a successful auditing strategy for the following end-to-end processes within CSC (i.e....
