Temporary Remote Grievance System Specialist

Advanced Health Coordinated Care Organization; United States; Remote; USD 31,000 - 40,000; Full time

Benefits offered by this job

Remote work option

Flexible scheduling

Job summary

Advanced Health Coordinated Care Organization is seeking a TEMPORARY Grievance System Specialist to support the member grievance system remotely from eligible states. The role involves processing grievances and appeals with adherence to timelines, communicating with members, providers, and staff, and ensuring regulatory compliance.

Qualifications include a High School Diploma or GED with preferred healthcare administration education, 1–2 years in managed care, and experience in investigations or

Qualifications

• Minimum High School Diploma or GED; associate or bachelor’s degree in business or healthcare administration preferred, experience in lieu of degree will be considered
• Minimum one to two years’ experience in managed care or other healthcare setting
• One to two years’ experience investigative, reporting, or information analysis strongly preferred
• THW Certification preferred, or willing to obtain
• Bilingual preferred, qualified, certified, or willing to obtain

Responsibilities

• Create and maintain positive relationships between organization, Advanced Health members, delegates, and providers
• Support the Member Grievance System life cycle, including denials, grievances, appeals, and hearings
• Conduct investigations and compile information from members, providers, and delegates
• Maintain knowledge of Oregon OARs, OHA guidelines, OHP benefits, and Advanced Health programs
• Ensure compliance with notices of adverse benefit determinations, grievances, appeals, and hearings

Skills

Grievance system knowledge

Investigation skills

Communication skills

Customer service

Bilingual (preferred)

Education

High School Diploma or GED

College degree preferred

Tools

Microsoft Office

Job description

Advanced Health Coordinated Care Organization is seeking a TEMPORARY Grievance System Specialist to support the member grievance system remotely from eligible states. The role involves processing grievances and appeals with adherence to timelines, communicating with members, providers, and staff, and ensuring regulatory compliance.

Qualifications include a High School Diploma or GED with preferred healthcare administration education, 1–2 years in managed care, and experience in investigations or