Complaints and Grievance Coordinator

SafeRide Inc; San Antonio (TX); On-site; USD 55,000 - 85,000; Full time

Job summary

SafeRide Health in San Antonio, TX seeks an experienced Complaints and Grievance Coordinator to process member grievances, appeals, and provider disputes in alignment with client requirements across lines of business.

You will document cases, maintain timelines, communicate with members and providers, generate updates for leadership, and collaborate with departments to ensure timely resolutions while upholding contractual standards.

Qualifications

• Minimum high school diploma or equivalent.
• Minimum one year in grievance and appeals processing.
• Minimum one year in an inbound call center environment.

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 involved in the work.
• Research the details and history of a case and create a clear timeline of events.
• Communicate with members and providers as needed.
• Update members and providers regarding progress of active and open cases.
• Prepare data related to complaints and grievances.
• Collaborate with departments to complete follow-up and research.
• Provide daily, weekly and monthly updates to leadership.
• Recommend solutions and coordinate with leadership to prevent recurrences.

Skills

Customer-oriented

Communication skills

Problem-solving

Analytical skills

Documentation

Interpersonal relationships

Education

High school diploma or equivalent

Associate’s degree

Job description

Job Summary:

SafeRide Health is seeking an experienced Complaints and Grievance Coordinator responsible for processing complaints and grievances, consisting of member grievances, appeals, and provider disputes. This role ensures that cases are resolved by client-specific requirements across all lines of business.

Primary 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

Required Education and Experience:

• 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

Preferred Education and Experience

• Experience with Medicaid, Medicare, and NEMT guidelines
  

• Associate’s degree in relevant discipline

• Knowledge of health insurance programs and benefits

Skills

• Customer-oriented with the ability to address customers’ needs while following company procedures.

• Outstanding problem-solving skills and ability to use soft skills in a high-stress environment

• Strong analytical skills and the ability to use thinking and logic to solve everyday issues

• Personable, with solid leadership and mentoring skills

• Strong communication skills (both verbal and written) and demonstrated ability to communicate, present, and influence effectively in person, via email, and over the phone

• Ability to meet contractual reporting requirements and deadlines

• Ability to adapt to unforeseen circumstances quickly

• Ability to respond to sensitive or complex issues with tact and sensitivity

• Proficiency in listening and problem-solving skills

• Ability to establish and maintain effective working relationships with members, coworkers, providers, and individuals of varying socio-economic and cultural backgrounds and with special needs populations

• Ability to effectively, clearly, and independently document, summarize and resolve member’s concerns and inquiries

About Us:

SafeRide Health is a technology and services company dedicated to reducing barriers to care by improving the delivery of non-emergency medical transportation to people across America. SafeRide Health leverages proprietary technology and a nationwide network of vetted transportation providers to give payers and health systems a more intelligent way to deliver cost-effective, on-demand transportation while improving the patient experience. SafeRide serves the largest Medicare Advantage, Medicaid, and provider programs in the country. Learn more at www.saferidehealth.com.