Grievance Specialist
Core
Resolve member grievances and Medicare Advantage appeals with accuracy, efficiency, and compassion while ensuring regulatory compliance.
Role type
Senior IC grievance specialist (healthcare)
Builds
Member trust and regulatory compliance in healthcare grievance resolution
Domain
Healthcare / Medicare Advantage
Deliverable
client delivery
Required skills
Medicare Advantage appeals experience, regulatory compliance knowledge, investigative analysis, conflict resolution, data accuracy, time management
Preferred skills
Healthcare background, insurance product knowledge, stakeholder collaboration, process improvement identification
Technologies
Multiple case management platforms
Responsibilities
Conduct thorough investigations by reviewing case details and member records; Triage and route grievances accurately; Communicate with members via written correspondence and telephone; Complete accurate documentation and data entry; Ensure grievances are resolved within regulatory timelines; Collaborate with internal partners to resolve cases; Identify themes for process improvements.
Seniority
Mid-level, hands-on IC