Member Grievance & Appeals Specialist

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

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.