Grievances Coordinator - Medicare Part D

Arizona, Rhode Island

Job Description

Coordinates grievance process as assigned, attends to risk management issues associated with case management and processes grievance requests.
  • Performs outreach contact and written notification with members with resolution to Grievances.
  • Consults with internal departments, to ensure Grievances resolutions meet all guidelines and result in customer satisfaction.
  • Responsible for preparation of written detailed case history.
  • Documents process and findings within the Grievance and internal systems.
  • Interfaces with members and providers as required regarding status, process and outcomes of complaints.
  • Maintains the integrity of the company relationship with customers by researching, resolving and responding to customer inquiries for disputes.
  • Identifies risk situations and escalates to supervisor as appropriate.
  • Researches, compiles and consults with external review organization and customers as necessary.
  • Achieves and maintains department performance goals.
  • Assists in developing workflows and innovative process improvements to positively impact the department overall.
  • Meets individual performance standards.
  • Other duties as assigned.

General Job Information

Title

Grievances Coordinator - Medicare Part D

Grade

18

Job Family

Quality Group

Country

United States of America

FLSA Status

United States of America (Non-Exempt)

Recruiting Start Date

9/16/2019

Date Requisition Created

9/16/2019

Work Experience

Customer Service

Education

Associates, GED (Required), High School (Required)

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • Experience in customer interactions and detailed review of health-related materials.
  • Strong interpersonal skills and attention to detail.
  • Ability to organize work and seek help on tasks where needed.
  • Ability and willingness to learn new software applications.
  • Professional writing and proofing skills required ensuring documents meet standards and are accurate.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

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