Grievances Coordinator (Monday-Friday)

PacificSource • Springfield, OR

1d • Onsite

About The Position

Coordinate the internal appeals and grievances process by supporting entry of requests in a meaningful and timely manner. Provide support as needed for the completion of appeals and grievances. Communicate information about appeals and grievances processes and outcomes to members and providers verbally and/or in writing. Support member and provider experience.

Requirements

• Minimum of two years customer service, claims processing or health insurance industry experience required.
• High School Diploma required
• Requires strong research, analytical and data entry skills.
• Must have basic math skills, the ability to work under strict deadlines, and excellent organizational skills.
• Accountability
• Collaboration
• Communication (written/verbal)
• Flexibility
• Listening (active)
• Organizational skills/Planning and Organization
• Problem Solving
• Teamwork
• Ability to read and comprehend both written and spoken English.
• Communicate clearly and effectively.

Nice To Haves

• 1 year of technical writing and conflict resolution experience preferred.
• Bachelor’s degree or equivalent experience preferred.
• Experience using Facets, OnBase, and other software packages used by PacificSource is strongly preferred.

Responsibilities

• Oversee and coordinate all Grievance activities ensuring response deadlines are met in accordance with applicable best practice, state and federal guidelines.
• Review grievance documentation, correspondence, and medical records when applicable to ensure complete categorization and response of complaints.
• Correspond with members and providers to enhance their experience throughout the grievance process.
• Draft and provide acknowledgements by applicable method, to inquiries and grievances as required by regulations, PacificSource policy and department process standards.
• Ensure accurate and complete entry of case specific information into the Health Management Platform
• Prepare and provide response and resolution by applicable method to inquiries and grievances as required by regulations, PacificSource policy and department process standards.
• Assist the Appeals and Grievances Support team in the entry of new appeals and grievances into the system.
• Meet department and company performance and attendance expectations.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

Benefits

• Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: We are committed to doing the right thing. We are one team working toward a common goal. We are each responsible for customer service. We practice open communication at all levels of the company to foster individual, team and company growth. We actively participate in efforts to improve our many communities-internally and externally. We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. We encourage creativity, innovation, and the pursuit of excellence.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED