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The Grievance team manages Cigna Medicare/Medicaid grievances that are presented by our member’s or their representatives pertaining to the authorization of or delivery of clinical and non-clinical services. Grievance works in collaboration with divisions within and outside the organization to resolve issues in a timely and compliant manner. Grievances coordinator position is focused on the processing of Medicare customer grievances. This associate may screen incoming complaints received orally or in writing, conducting root cause analysis as needed, creating an action plan, coordinating and communicating resolutions, as well as documenting systems in detail with case notes related to Customer grievances with in CMS guidelines. Duties and Responsibilities: • Grievance Coordinator is responsible for corresponding with members, providers and regulators regarding decisions and actions. • Works collaboratively with the Claims, Customer Service, Appeals, and Medical Management Departments. • Communicate, collaborate and cooperates with internal and external business partners. • Adheres to all Compliance/Program Integrity requirements and complies with HIPAA Regulations and must meet/exceed compliance and production goals. • Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency. • Supports department-based goals which contribute to the success of the organization. CANDIDATE QUALIFICATIONS: • Bachelors or associates degree in related field; in lieu of a degree, a high school diploma and two years in a Medicare, Medicaid managed care environment investigating and resolving Grievances, preferred. • One year of health insurance/managed care experience knowledge of healthcare terminology preferable. • Strong written and verbal communication skills, PC proficiency to include Microsoft office products. • One year of health insurance/managed care experience performing Appeals and Grievances functions preferred. • Will consider managed care associates with three years of experience in customer service, call center or claims processing skills and knowledge of healthcare delivery. • Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment. • Demonstrated written communication skills, time management, priority setting, problem solving and organizational skills. • Demonstrated ability to converse with and collaborate with physicians and physician personnel. • Ability to identify and define problems, collect data/information, establish facts, and draw valid conclusions and provide resolution. • Ability to track and manage case load effectively in Grievance tracking system • Must be able to work independently and under pressure related to tight time-frames

JOB REQUIREMENTS:
* High school diploma OR GED.
* 2 years customer service experience in a health care or insurance environment.
* Experience evaluating customer situations, making decisions, and responding quickly to questions.
* Experience handling escalated customer issues from lower level Customer Advocates.
* Clear and concise verbal and written communication skills.
* Interpersonal and analytical skills.
* Data entry and/or typing experience.

PREFERRED JOB REQUIREMENTS:

* 1+ year grievance experience

* 1+ year Medicare experience
* 3 years customer service experience.
* 2 years data entry experience in an office environment.
* Knowledge of Managed Care Programs.
* Knowledge of medical terminology and anatomy.

Hybrid/Flex: Rotating schedule of 2 weeks remote followed by 1 week in office.

Compensation: $18.10 - $37.10

Exact compensation may vary based on skills, experience, and location

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

To learn more about available benefits, please click https://careers.hcsc.com/totalrewards