Appeals and Grievances Training Specialist
3 weeks ago
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 lead 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 recommend 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 in using Word, Excel, Power Point and Access.
-
Appeals and Grievance Coordinator
3 days ago
Los Angeles, United States Imperial Health Plan of California, Inc. Full timeJOB TITLE: Appeals and Grievance Coordinator FLSA STATUS: Non-Exempt DEPARTMENT: Appeals and Grievances REPORTS TO: Supervisor, Appeals & Grievances JOB SUMMARY: Responsible for reviewing and resolving member complaints and appeals and communicating resolution to members in accordance with the standards and requirements established by Medicare and...
-
Customer Solution Center Appeals and Grievances
9 hours ago
Los Angeles, United States L.A. Care Health Plan Full timeCustomer Solution Center Appeals and Grievances Quality Auditing Specialist II **Job Category**:Customer Service**Department**:CSC Appeals & Grievances**Location**:Los Angeles, CA, US, 90017**Position Type**:Full Time**Requisition ID**:10219**Salary Range**: $67,186.00 (Min.) - $87,342.00 (Mid.) - $107,498.00 (Max.)- Established in 1997, L.A. Care Health...
-
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 L.A. Care Health Plan Full timeCustomer 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...
-
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $117, Min.) - $152, Mid.) - $188, 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...
-
APPEALS & GRIEVANCES NURSE SPECIALIST RN
1 week ago
Los Angeles, CA 90017, USA, United States Mitchell Martin Full timeOur Client, Provides health insurance for low-income individuals, is seeking an Appeals & Grievances Nurse Specialist RN.Location: Los Angeles, CA (Remote)Position Type: ContractJob summary: • The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides direct assistance to member's with health care access or...
-
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, 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: $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...
-
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary 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...
-
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $88, Min.) - $115, Mid.) - $142, 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: $47, Min.) - $57, Mid.) - $68, 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: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (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: $88, Min.) - $115, Mid.) - $142, 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: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (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 members...
-
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (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, 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...
