Grievance and Appeals Associate

Overview

Under the direction of Grievance Supervisor, the Grievance and Appeals Associate is responsible for monitoring all incoming cases, recording them in Everest, and assigning new cases to the appropriate Grievance Staff.   Provides clerical support to Grievance Staff by ensuring all correspondence is printed and mailed timely, according to DHCS timeframes and HIPAA confidentially laws.  Responsibilities also include accepting incoming calls on the ACD phone system, assisting customers.  Performs other administrative and/or clerical support to the department and/or management as needed.

Responsibilities

• Actively monitors Everest for new incoming cases from Member Services and/or filed online directly by members. Ensures preliminary case categories are recorded accurately and assigns cases to the appropriate G&A staff, according to department guidelines.  
• Actively manages the department’s Case Assignment Tracker by recording all assigned cases
• Opens, sorts, date stamps, and distributes all department mail. Assesses new incoming mail for new Appeals or Grievances and follows protocols for entering and assigning cases in Everest.
• Prints, stuffs, and mails all correspondence supporting case investigations and/or State Hearings
• Answers incoming calls on the ACD phone with the highest level of customer service.
• Ensures that customers’ questions are addressed and/or direct calls to the appropriate person for resolution.
• Monitors all shared G&A mailboxes and handles email accordingly to department guidelines
• Review accuracy of all invoices submitted by Supervisors, obtains Director’s signature for approval, and submits approved invoices to Finance or other appropriate department for payment. Tracks and files all paid invoices.
• Creates and submits IT tickets to support onboarding of new hires. May copy and create new binders for training material
• Participates in special department projects and assignments as
• Provides administrative and/or clerical support to management and G&A staff as needed to support the department.
• Other duties as assigned. 

Qualifications

Education and Experience

High School Diploma or equivalent; minimum one (1) year administrative experience required. Call center experience a plus.

Special Skills, Licenses and Certifications

Proficiency in multiple software applications including Microsoft Office Suite and SharePoint preferred. Strong organizational and multi-tasking skills. Excellent interpersonal and customer service skills.

Performance Based Competencies

Effective verbal and written communication skills. Excellent organization skills with ability to prioritize assignments and maintain effective filing systems and meet deadlines. Ability to use good judgment and to handle confidential and sensitive issues with tact and diplomacy. Ability to understand and follow instructions. Ability to effectively exercise good judgment within scope of authority. Ability to accurately complete tasks within established times.

Work Environment And Physical Demands

Type 25 wpm.  Use of telephone, fax, computer and Biz-hub machine are required. More than 50% of work time is spent in front of a computer monitor. When required, ability to move, carry or lift objects of varying sizes weighing up to 25 lbs. Must be able to work in a fast paced environment and maintain courtesy and composure when dealing with internal and external customers. Ability to prioritize work load and initiate action to acquire needed information from professionals by phone. Ability to function effectively with frequent interruptions and directions from multiple team members.

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated 

HIRING RANGE:

$26.25 - $30.84

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

Salary : $26 - $31