Grievance and Appeals Coordinator, South San Francisco, CA
GRIEVANCE AND APPEALS COORDINATOR
(New Grads with Exceptional Writing Skills Encouraged to Apply!)
The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Grievance and Appeals Coordinator to implement HPSM’s Grievance and Appeals processes by resolving complaints filed by HPSM members and their representatives. The essential duties and responsibilities will include the following:
- Research and resolve member complaints for all lines of business ensuring compliance with HPSM’s Grievance and Appeals policies and procedures.
- Maintain grievance and appeals case files in HPSM’s database.
- Effectively communicate with members and providers verbally and in writing.
- Prepare summaries and write resolution letters for members, which include summarizing member complaints and steps taken to resolve complaints in clear and grammatically correct language.
- Attend and present cases at bi-weekly Staff Grievance and Appeals Committee.
- Prepare files for appeals to regulatory agencies.
- Maintain current on all regulatory requirements as they apply to grievance and appeal processes.
- May provide necessary coverage in the call centers for Member Services and CareAdvantage, as needed.
Education and Experience: Associate’s degree in health, business, social sciences, or humanities, preferred. Two (2) years of experience working with Medi-Cal or Medicare in a managed care environment preferred. Work performing grievance and appeals processing preferred. Work in a call center, claims department, and/or other customer service position required.
Knowledge of: Medicare, Medi-Cal, Managed Care and medical terminology preferred. Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, and PowerPoint.
Ability to: Communicate effectively and professionally, both verbally and in writing. Summarize information clearly, thoroughly, and quickly in writing. Deal with difficult people and situations while providing quality customer service. Use sound judgment, identify next steps to be taken and develop appropriate solutions. Collaborate with multiple parties to solve problems as well as the ability to solve problems independently.
Starting Compensation Between $25.40/hour - $34.92/hour – depending on experience.
Other: Fluency in Spanish, Tagalog or Chinese (Mandarin/Cantonese) languages are highly preferred.
Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s coverage in the medical HMO plan and majority of PPO medical cost. Employee pays a small portion of the dependent premiums for medical and dental benefits. Additional HPSM benefits include fully paid vision, life, AD&D, STD, and LTD insurance; retirement plan (10% of salary for compensation/HPSM paid); holiday and vacation pay; tuition reimbursement plan; and more.
Application Process: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via email: firstname.lastname@example.org or via fax: (650) 616-8039. File by: Continuous until filled. EOE