Complaints and Grievance Coordinator

SafeRide Health•San Antonio, TX

3d•Hybrid

About The Position

SafeRide Health is seeking an experienced Complaints and Grievance Coordinator responsible for processing complaints and grievances, consisting of member grievances, appeals, and provider disputes. This role ensures that cases are resolved by client-specific requirements across all lines of business.

Requirements

Minimum High school diploma or equivalent
Minimum one (1) year in grievance and appeals processing
Minimum one (1) year in an inbound call center environment
Customer-oriented with the ability to address customers’ needs while following company procedures.
Outstanding problem-solving skills and ability to use soft skills in a high-stress environment
Strong analytical skills and the ability to use thinking and logic to solve everyday issues
Personable, with solid leadership and mentoring skills
Strong communication skills (both verbal and written) and demonstrated ability to communicate, present, and influence effectively in person, via email, and over the phone
Ability to meet contractual reporting requirements and deadlines
Ability to adapt to unforeseen circumstances quickly
Ability to respond to sensitive or complex issues with tact and sensitivity
Proficiency in listening and problem-solving skills
Ability to establish and maintain effective working relationships with members, coworkers, providers, and individuals of varying socio-economic and cultural backgrounds and with special needs populations
Ability to effectively, clearly, and independently document, summarize and resolve member’s concerns and inquiries

Nice To Haves

Experience with Medicaid, Medicare, and NEMT guidelines
Associate’s degree in relevant discipline
Knowledge of health insurance programs and benefits

Responsibilities

Maintain contractual compliance and customer satisfaction
Ensure that all assigned complaints and grievances are completed by the deadline and other contractual requirements
Respond to Comment Letters and client inquiries and requests
Ensure interactions remain positive and professional with all persons with whom you and the Complaints and Grievance Team interact in the course of your work, both internally and externally
Researching the details and history of a case and creating a clear timeline of events
Communicating, both orally and in writing, with members and providers as needed
Updating members and providers regarding the progress of active and open cases
Requesting, reviewing, sorting, and preparing data related to complaints and grievances
Working with relevant departments to complete all necessary follow-up and research
Complaint and grievance escalations
Interdepartmental and Client Communication
Provide daily, weekly and monthly complaint and grievance updates to leadership
Recommend solutions and work with internal department leadership to ensure problems are corrected, and departments are advised of corrective measures to prevent recurrences
Provide complaint and grievance data to leadership regarding provider complaint and grievance trends
Other duties as assigned