Complaint & Grievance Process Administrator (Operations & Policy Analyst 3)

State of Oregon • Salem, OR

10d • Hybrid

About The Position

The Medicaid Division designs, administers, and continually improves Oregon Health Plan (OHP) programs, ensuring services are delivered effectively, equitably, and in alignment with state and federal requirements. Within the division, the CCO Services Unit supports Coordinated Care Organizations (CCOs) by offering technical assistance, resolving complex operational issues, and collaborating with partners to strengthen policies, systems, and service delivery. The Complaint and Grievance Process Administrator oversees the Medicaid Division’s complaint process for OHP members and providers. This position leads efforts to monitor compliance with federal and state requirements, identify and analyze complaint trends, and support quality improvement initiatives that strengthen accountability and member experience. The role ensures alignment of complaint processes across OHA and ODHS programs, and provides training, guidance, and technical assistance to internal and external partners. It also represents the division by communicating policy, program, and regulatory information to legislators, state and federal partners, community organizations, and other partners. This position will collaborate with diverse populations most harmed by social injustice and inequities and will demonstrate the ability to build and steward positive, collaborative and partnership-based relationships with diverse community groups including communities of color, immigrant groups, the disability and neurodivergent communities, veterans, older adults, individuals identifying as LGBTQIA2S+ and other communities that have been traditionally marginalized.

Requirements

• A Bachelor's Degree in Business or Public Administration, Behavioral or Social Sciences, Finance, Political Science or any degree demonstrating the capacity for the knowledge and skills; and four years professional-level evaluative, analytical and planning work.
• Any combination of experience and education equivalent to seven years of experience that typically supports the knowledge and skills for the classification.

Nice To Haves

• Experience supporting the development, implementation, oversight, or evaluation of complaint, grievance, appeals, quality assurance, or compliance-related programs that improve access, accountability, and equitable service delivery within healthcare or public sector systems.
• Knowledge of health services delivery systems, particularly the Oregon Health Plan (OHP), Medicaid administration, Coordinated Care Organizations (CCOs), health plans, healthcare providers, or other complex health and human services systems.
• Knowledge of federal and state laws, regulations, and compliance requirements related to Medicaid, grievance and appeals processes, quality assurance, or consumer protections; experience analyzing and applying regulatory requirements to operational practices.
• Experience evaluating and synthesizing quantitative and qualitative data to identify trends, assess program performance, monitor outcomes, and support policy, operational, or quality improvement decisions.
• Experience leading or supporting continuous quality improvement, performance improvement, or process improvement initiatives, including the development of performance measures, metrics, corrective actions, and outcome monitoring.
• Ability to foster collaboration and build effective working relationships across agencies, health plans, providers, advocacy organizations, community partners, and individuals with lived experience to improve programs, services, and outcomes.
• Strong oral and written communication skills across a variety of forums; experience communicating complex information, technical requirements, and data findings in ways that are accessible, culturally responsive, and appropriate for diverse audiences.
• Demonstrated project management experience, including the ability to manage multiple priorities, coordinate complex initiatives, meet regulatory timelines, and support successful implementation of operational or policy changes.

Responsibilities

• Oversees the Medicaid Division’s complaint process for OHP members and providers.
• Leads efforts to monitor compliance with federal and state requirements.
• Identifies and analyzes complaint trends.
• Supports quality improvement initiatives that strengthen accountability and member experience.
• Ensures alignment of complaint processes across OHA and ODHS programs.
• Provides training, guidance, and technical assistance to internal and external partners.
• Represents the division by communicating policy, program, and regulatory information to legislators, state and federal partners, community organizations, and other partners.
• Collaborates with diverse populations most harmed by social injustice and inequities.
• Builds and stewards positive, collaborative and partnership-based relationships with diverse community groups including communities of color, immigrant groups, the disability and neurodivergent communities, veterans, older adults, individuals identifying as LGBTQIA2S+ and other communities that have been traditionally marginalized.

Benefits

• Excellent, low-cost medical, vision, and dental coverage for you and your family.
• Optional benefits like life insurance, disability coverage, deferred compensation, and FSA options for health and childcare.
• Generous paid time off: 11 holidays, 3 personal days, monthly sick leave, and vacation accrual starting at 8 hours/month.
• Potential eligibility for the Public Service Loan Forgiveness Program.
• Retirement security through Public Employees Retirement System (PERS)/Oregon Public Service Retirement Plan (OPSRP).
• Training and development opportunities to grow your career with the State of Oregon.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level