Grievances & Appeals Specialist
About The Position
Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! Modivcare is looking for an experienced Grievances & Appeals Specialist to join our team! This position is responsible for establishing superior customer service and to reduce the number of official complaints through positive and effective working relationships with customers, providers, and agencies. This role will work identify root causes of issues and provide real time solutions for members that have a high risk for service failure. This role... Handles high-risk member complaints and grievances. Collects all necessary supporting information to accurately provide a resolution. Works closely with other work streams to provide permanent solutions for high-risk members. Records and initiates investigation of complaints, grievances, and general issues via all incoming communication channels. Engages stakeholders, government agencies, clients, and/or legal department to hand off issues outside the scope of work and causing transportation roadblocks. Monitors the complaint aging report to comply with turnaround requirements on resolution. Monitors member trips. Participate in other projects or duties as assigned.
Requirements
- High School Diploma required.
- Two (2) plus years of experience. Or equivalent combination of education and/or experience.
- Excellent customer service and proper phone etiquette skills
- Excellent verbal communications, problem solving, time management and organizational skills.
- Effectively manage a high volume of work.
- Ability to quickly learn modern technology.
- Ability to accurately type 35+ corrected words (WPM).
- Proficient in reading and writing in English.
- Proficient in Microsoft Word, Excel, and Outlook.
- Ability to work independently or with a team as necessary.
Nice To Haves
- Medical front-office, medical case management, and/or medical social work experience a plus.
- Bi-lingual a plus.
Responsibilities
- Handles high-risk member complaints and grievances.
- Collects all necessary supporting information to accurately provide a resolution.
- Works closely with other work streams to provide permanent solutions for high-risk members.
- Records and initiates investigation of complaints, grievances, and general issues via all incoming communication channels.
- Engages stakeholders, government agencies, clients, and/or legal department to hand off issues outside the scope of work and causing transportation roadblocks.
- Monitors the complaint aging report to comply with turnaround requirements on resolution.
- Monitors member trips.
- Participate in other projects or duties as assigned.
Benefits
- Medical, Dental, and Vision insurance
- Employer Paid Basic Life Insurance and AD&D
- Voluntary Life Insurance (Employee/Spouse/Child)
- Health Care and Dependent Care Flexible Spending Accounts
- Pre-Tax and Post --Tax Commuter and Parking Benefits
- 401(k) Retirement Savings Plan with Company Match
- Paid Time Off
- Paid Parental Leave
- Short-Term and Long-Term Disability
- Tuition Reimbursement
- Employee Discounts (retail, hotel, food, restaurants, car rental and much more!)
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
