Grievance Coordinator

Lumeris Inc.; EUA; Teletrabalho; USD 44 000 - 55 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Medical, Vision and Dental Plans

401k with company match

Paid Time Off (PTO, Sick Time, Paid/Le

Resumo da oferta

Lumeris is seeking a Grievance Coordinator to support the Medicare Grievances Program, driving investigations and resolutions that reflect members' concerns. You will coordinate with internal and external partners, document actions, and ensure timely, accurate responses in a high-touch environment.

The role requires a Bachelor's degree or equivalent and at least 1 year of related experience, with strong ethics, communication, and analytical skills to improve member experience.

Qualificações

• Bachelor's degree or equivalent.
• 1+ years of related work experience.
• Ability to maintain high ethical standards.
• Good critical thinking and problem-solving skills.
• Ability to multi-task and operate in remote and in-person settings.
• Strong investigatory skills to assess risk and response.

Responsabilidades

• Conduct thorough investigations into member complaints and achieve resolution.
• Utilize senior resources as needed to reach outcomes.
• Perform root cause analysis on escalated grievances.
• Gather information, outreach with members and providers, and assess resolutions.
• Document investigations as a complete chronological record for each case.
• Ensure resolutions address all components of the complaint.
• Track multiple cases in a high-volume environment while maintaining quality.
• Communicate status in weekly internal meetings and escalate as needed.
• Demonstrate knowledge of complaint processes and plan operations.

Conhecimentos

Investigations

Root cause analysis

Problem solving

Communication

Multitasking

Ethics

Formação académica

Bachelor's degree or equivalent

Descrição da oferta de emprego

Position: Grievance Coordinator

Works an important part of the Medicare Grievances Program, which is the heartbeat of Plan operations and a direct insight to member experience. Reviews and investigates member complaints and works with internal and external partners to reach mitigation and resolution for the member. Handles each grievance in accordance with organizational and regulatory guidelines.

Primary Responsibilities

• Conducts thorough investigations into member complaints, identifies all issues or components of the grievance, and achieves resolution through action and education to the member.
• Utilizes senior resources as needed.
• Conducts rigorous root cause analysis on escalated member grievances, using structured diagnostic techniques to identify underlying system, plan, or provider issues.
• Researches, gathers information and evidence, and conducts timely outreach with members, providers, internal and external partners, reviews issues, and assesses appropriate resolution.
• Documents investigation as an accurate and complete chronological record of actions taken, communication and information obtained, and member resolution and notification for each grievance.
• Ensures grievance resolution reflects the member's complaint and accurately and completely addresses all components of the complaint.
• Keeps track of several cases simultaneously while making sure each member gets the attention they deserve in a high-volume, high-touch environment.
• Creates and maintains good rapport and collaborates effectively in all areas of the organization.
• Recognizes urgent and sensitive issues/incidents and escalates in a timely manner to facilitate appropriate and timely response.
• Communicates the status of assignments in weekly internal meetings for discussion and direction.
• Demonstrates sufficient knowledge of complaint and understanding of related plan processes or functions to adequately articulate issue and resolution.

Qualifications

• Bachelors degree or equivalent
• 1+ years of related work experience or the knowledge, skills, and abilities to succeed in the role
• Ability to maintain high ethical standards
• Good critical thinking and problem-solving skills
• Ability to multi-task and operate effectively in both remote and in-person settings
• Skilled problem-solver with the ability to take on basic problems and achieve a solution within a reasonable amount of time
• Good investigatory skills with ability to organize, review, and effectively assess risk and appropriate response
• Ability to remain fair and identify facts
• Organizational skills for prioritizing tasks to meet set deadlines
• Good communication and interpersonal skills with the ability to interact at all levels
• Good customer service skills

Working Conditions

While performing the duties of this job, the employee works in normal office working conditions.

#LI-Remote

Pay Transparency

Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. In addition to the base salary, certain roles may qualify for a performance-based incentive and/or equity, with eligibility depending on the position. These rewards are based on a combination of company performance and individual achievements.

The hiring range for this position is: $44,100.00-$54,825.00

Benefits of working at Lumeris

• Medical, Vision and Dental Plans
• Tax-Advantage Savings Accounts (FSA & HSA)
• Life Insurance and Disability Insurance
• Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days)
• Employee Assistance Program
• 401k with company match
• Employee Resource Groups
• Employee Discount Program
• Learning and Development Opportunities
• And much more...

Be part of a team that is changing healthcare!

Member Facing Position: Yes- Member or Patient Facing Position

Drug Screen Requirement: No MVR Required: No Credit Check Required: No

Location: Remote, USA Time Type: Full time

Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment.

Disclaimer: The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job.

Reasonable accommodations may be made to enable individual with disabilities to perform the essential job duties and responsibilities.

Lumeris is an EEO/AA employer M/F/V/D.

Join Our Growing Team!

Lumeris is bringing common sense back to the business of healthcare by empowering value-based care. We create the partnerships and perspectives that are making healthcare safer, more affordable and more personalized for providers, patients and payers alike. We were founded on the belief that it should be easier to provide the right care, at the right time, at the right cost. Our model is bringing that belief to life, improving outcomes and empowering financial sustainability along the way.

Why Join Lumeris?

At Lumeris, we will be part of team that is focused on solving the nation’s healthcare problem, and you will be able to contribute to our purpose. Our environment is fast-paced, change-oriented and focused on growth and employee engagement. At Lumeris, we know that talent is best utilized when given the opportunity to succeed. That is why we have removed the boundaries that inhibit success and focus on fostering a environment that allows employees to utilize their talents.