Program Assistant (GARS)

JOHNSON SERVICE GROUP; Orange (CA); On-site; USD 33,000 - 46,000; Full time

Benefits offered by this job

Weekly pay

Medical, dental, vision

Job summary

Johnson Service Group (JSG) is seeking a Customer Service/Claims Assistant for a Health Plan Partner. This on-site role in Orange County, CA offers a Mon-Friday 8am-4pm schedule with a pay range of $24-$33.50 per hour.

Primary duties include program support and handling grievances and appeals, plus administrative and documentation tasks. Ideal candidates will have a high school diploma or equivalent and at least 1 year of relevant experience, with bilingual capabilities in English and a

Qualifications

• High school diploma or equivalent plus 1 year of experience in appeal and grievance guidelines; Medi-Cal/Medicaid or Medicare programs experience preferred.
• Bilingual in English and one threshold language (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).

Responsibilities

• Assist the team with department responsibilities and support short- and long-term goals.
• Serve as the primary contact for inquiries related to grievances and appeals.
• Monitor complaints via the Customer Service system from members/providers and routes for resolution.
• Coordinate state and federal DMHC/Medicare/DMHC requests and document in the GARS system.

Skills

Customer service

Grievance handling

Communication

Education

High school diploma or equivalent

Job description

Johnson Service Group (JSG) is seeking a Customer Service/ Claims Assistant at a Health Plan Partner.

This position is on-site in Orange County, CA.

Work Schedule: Mon-Friday 8am-4pm

Pay Range: $24-$33.50 per hour

Duties & Responsibilities

80% - Program Support

1. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
2. Serves as the point of contact within or outside Company for inquiries related to grievances and appeals.
3. Monitors incoming complaints via the Customer Service system routing, interdepartmental referral, mail, telephone, fax or via email from the website for members and providers.
4. Monitors inquiry requests from the Department of Managed Health Care (DMHC), Medicare Complaint Tracking Module (CTM) from the Centers for Medicare Medicaid Services (CMS), Medicare Quality Improvement Organization (QIO) and the State Hearing Office from Department of Social Services (DSS).
5. Responds to DMHC requests for information in a timely manner.
6. Sets up complaint case files, enters cases in the GARS system with accurate classification and category types and assigns them to appropriate staff.

15% - Administrative Support

1. Works with internal and external departments and providers in gathering supporting information relevant to the case.
2. Generates acknowledgment letters for all lines of business per department and regulatory standards.
3. Assists in the development of departmental forms and intake processes.
4. Coordinates administrative support for state hearings, serves as a contact with DSS for incoming cases, enters cases in the GARS system, creates electronic files and routes the scanned documents to designated staff and fax required state hearing documentation to the local hearing office as necessary.

5% - Other

1. Completes other projects and duties as assigned.

Minimum Qualifications

High school diploma or equivalent required PLUS 1 year of experience in appeal and grievance guidelines, Medi-Cal/Medicaid or Medicare programs required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.

Preferred Qualifications

Bilingual in English and in one of Company defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).

Benefits

1. JSG offers medical, dental, vision, life insurance options, short-term disability, 401(k), weekly pay, and more.

Equal Opportunity

Johnson Service Group (JSG) is an Equal Opportunity Employer.

JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law.

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