Grievance Coordinator

Lumeris

1d•$44,100 - $54,825•Remote

About The Position

The Grievance Coordinator is an important part of the Medicare Grievances Program, which supports plan operations and provides insight into member experience. The role reviews and investigates member complaints and works with internal and external partners to reach mitigation and resolution for members. Each grievance must be handled in accordance with organizational and regulatory guidelines. This is a remote, full-time, member-facing position based in the United States. The employee works in normal office working conditions. The hiring range is $44,100.00–$54,825.00. Candidates must be authorized to work in the United States; visa sponsorship is not available for this role. Because the position is identified as member-facing, proof of completion of the initial series of an approved COVID-19 vaccine is required as a condition of employment.

Requirements

Bachelor's degree or equivalent.
At least 1 year of related work experience, or the knowledge, skills, and abilities to succeed in the role.
Ability to maintain high ethical standards.
Critical-thinking and problem-solving skills.
Ability to multitask and work effectively in remote and in-person settings.
Ability to solve basic problems within a reasonable amount of time.
Investigatory skills, including the ability to organize, review, assess risk, and determine an appropriate response.
Ability to remain fair and identify facts.
Organizational skills to prioritize tasks and meet deadlines.
Communication and interpersonal skills to interact at all levels.
Customer service skills.
Authorization to work in the United States; visa sponsorship is not available.
Completion of the initial series of an approved COVID-19 vaccine is required because the position is member-facing.

Responsibilities

Conduct thorough investigations into member complaints, identify all grievance issues or components, and resolve them through action and education, using senior resources as needed.
Perform root cause analysis on escalated member grievances to identify underlying system, plan, or provider issues.
Research and gather information and evidence; conduct timely outreach to members, providers, and internal and external partners; review issues and assess appropriate resolutions.
Document each investigation as an accurate, complete chronological record of actions, communications, information obtained, resolution, and member notification.
Ensure grievance resolutions reflect the member's complaint and fully address all components.
Manage several cases simultaneously in a high-volume, high-touch environment while giving each member appropriate attention.
Build rapport and collaborate effectively across the organization.
Recognize urgent and sensitive issues or incidents and escalate them promptly to facilitate an appropriate response.
Communicate assignment status in weekly internal meetings for discussion and direction.
Demonstrate sufficient knowledge of complaints and related plan processes or functions to articulate issues and resolutions.

Benefits

Medical, vision, and dental plans.
Tax-advantage savings accounts (FSA and HSA).
Life insurance and disability insurance.
Paid time off, sick time, paid leave, volunteer days, and wellness days.
Employee Assistance Program.
401(k) with company match.
Employee Resource Groups.
Employee discount program.
Learning and development opportunities.
Certain roles may qualify for performance-based incentives and/or equity, subject to eligibility.