Bilingual Complaints and Grievance Coordinator processing member grievances and appeals in a hybrid role at SafeRide Health. Ensuring contractual compliance and customer satisfaction with clear communication.
Responsibilities
Maintain contractual compliance and customer satisfaction
Ensure that all assigned complaints and grievances are completed by the deadline and other contractual requirements
Respond to Comment Letters and client inquiries and requests
Ensure interactions remain positive and professional with all persons with whom you and the Complaints and Grievance Team interact in the course of your work, both internally and externally
Researching the details and history of a case and creating a clear timeline of events
Communicating, both orally and in writing, with members and providers as needed
Updating members and providers regarding the progress of active and open cases
Requesting, reviewing, sorting, and preparing data related to complaints and grievances
Working with relevant departments to complete all necessary follow-up and research
Complaint and grievance escalations
Interdepartmental and Client Communication
Provide daily, weekly and monthly complaint and grievance updates to leadership
Recommend solutions and work with internal department leadership to ensure problems are corrected, and departments are advised of corrective measures to prevent recurrences
Provide complaint and grievance data to leadership regarding provider complaint and grievance trends
Other duties as assigned
Requirements
Minimum High school diploma or equivalent
Minimum one (1) year in grievance and appeals processing
Minimum one (1) year in an inbound call center environment
Experience with Medicaid, Medicare, and NEMT guidelines
Associate’s degree in relevant discipline
Knowledge of health insurance programs and benefits
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