Grievance & Appeals Coordinator I
As a Grievance and Appeals Coordinator, you will follow procedures to resolve complaints filed by HPSM members and their representatives, ensuring that their concerns are addressed promptly and effectively. You will also provide backup support for our Member Services and CareAdvantage teams. Bring your passion to a rewarding career that makes a real difference in the community. A remote work option is available for California residents. This position is not eligible for sponsorship.
Position overview
- Speak with members and providers on the phone to gather information about cases.
- Communicate with people calmly and respectfully (even when someone is not calm and respectful).
- Write letters to members that help them feel heard and offer resolutions to their concerns.
Key responsibilities
- Research and document problems affecting members.
- Outreach to providers and other partners to resolve member complaints.
- Maintain detailed grievance and appeals case files in HPSM’s database
- Prepare files for appeals to regulatory agencies and regulatory audits
- Abide by grievance and appeals processes and regulatory requirements.
Requirements
These are the qualifications typically needed to succeed in this position. However, you don’t need to meet every requirement to apply.
Education and experience
- Associate’s degree in health, social sciences or humanities (preferred)
- Experience working in a call center, patient relations or other customer service position (required)
- Two years of experience working with Medi-Cal or Medicare in a managed care environment (preferred)
- Experience performing grievance and appeals processing (preferred)
Knowledge and ability
- Computer applications, including proficiency in Microsoft Office Suite
- Medicare, Medi-Cal, managed care and medical terminology (preferred)
- Work as part of a professional team as well as independently
- Thrive in a fast-paced and collaborative team environment
- Provide quality customer service at all times
- De-escalate challenging situations in which people may be upset
Salary and benefits
The starting salary range: $26.00 - $34.00 per hour (depending on the candidate’s work experience).
Excellent benefits package includes:
- HPSM-paid premiums for employee’s medical, dental and vision coverage (employee pays 10% of each dependent’s premiums)
- Fully paid life, AD&D and LTD insurance
- Retirement plan (HPSM contributes equivalent of 10% of annual compensation on top of salary)
- 13 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year
- Tuition reimbursement plan
- Employee wellness program
Other details
- Pay Type Hourly
- Telecommute % 10
- Job Start Date Thursday, September 5, 2024
- Health Plan of San Mateo, 701 Gateway Blvd., South San Francisco, California, United States of America
- Virtual