Grievances Coordinator (Monday-Friday)

PacificSource Health Plans • Bend, OR

3d • Hybrid

About The Position

PacificSource is seeking a Grievances Coordinator to manage the internal appeals and grievances process. This role involves supporting the entry of requests, providing assistance for the completion of appeals and grievances, and communicating process information to members and providers. The Grievances Coordinator will play a key role in supporting the member and provider experience by ensuring timely and accurate handling of complaints and inquiries in accordance with best practices, state, and federal guidelines. The position requires strong organizational skills, attention to detail, and the ability to work effectively under strict deadlines within a general office setting, with occasional travel.

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.
• Ability to work under strict deadlines.
• Excellent organizational skills.
• Stoop and bend.
• Sit and/or stand for extended periods of time while performing core job functions.
• Repetitive motions to include typing, sorting and filing.
• Light lifting and carrying of files and business materials.
• 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

• Flexible telecommute policy
• medical, vision, and dental insurance
• incentive program
• paid time off and holidays
• 401(k) plan
• volunteer opportunities
• tuition reimbursement and training
• life insurance
• flexible spending account

What This Job Offers

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