Grievances Coordinator - Medicare Part D
Arizona, Rhode Island
Job DescriptionCoordinates 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
TitleGrievances Coordinator - Medicare Part D
Job FamilyQuality Group
CountryUnited States of America
FLSA StatusUnited States of America (Non-Exempt)
Recruiting Start Date9/16/2019
Date Requisition Created9/16/2019
Work ExperienceCustomer Service
EducationAssociates, GED (Required), High School (Required)
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
- 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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