NEW JOB OPENING
MEDICARE CASE MANAGER : COMPLAINTS & GRIEVANCES
IN Corona, CA, USA!

· Required Level of Education: High School Diploma

· Preferred Level of Education: College Degree



· Remote Options (Fully Remote, Partially Remote, Client Onsite): Fully Remote, with the exception of equipment. Please advise could be up to 14 days.

· Will the worker need to be Remote local to the office or Remote anywhere in the US: in the specific region and area of contact site – SCAL = Corona,

· Address: SCAL: Corona, CA

· Parking Situation: Site parking available.

· Any Travel for this role?: No, unless needing to come in office due to network, power, or other issue requiring in person presence.





Position details: Case Manager – HS (Medicare Disruption) work.





Major Responsibilities/Essential Functions:



· Participate in managing the organization's complaint and grievance process.

· Accountable for investigation of all issues, including collection and documentation of appropriate data.

· Identify and address specialty / flagged cases and follow appropriate processes for different types of cases Communicate with a diverse set of internal and external clientele to achieve excellent results in the areas of complaint and grievance handling, compliance, documentation and enhancement of the member experience.

· Partner with and outreach to internal staff, other MS Departments, managers and physicians to resolve issues as quickly as possible.

· Research, resolve and communicate complaints and grievances filed by members and communicate Health Plan's decisions appropriately back to member or their authorized representatives Ensure that complaints and grievances are processed in accordance with regulations, compliance standards and policies and procedures.

· Meet timeframes for performance while balancing the need to produce high quality work related to complex and sensitive member issues.

· Ensure integrity of departmental database by thorough, timely and accurate entry, consistent with regulatory protocols and effectively manage case resolution inbox everyday Participate in departmental meetings, trainings and audits as requested.

· Answer questions and manage members on existing / open cases Escalate issues to management as appropriate to maintain compliance.



Minimum Work Experience and Qualifications:



· Experience in a service related industry, call center experience preferred.

· Excellent interpersonal, verbal and written communication skills.

· Ability to work with peers in self-managed teams.

· Ability to prioritize work and ensure all compliance elements are met.

· Demonstrated conflict resolution and mediation skills with ability to secure action from multiple stakeholders. Ability to use sound judgment and to handle complex issues independently, but with the knowledge and ability to escalate and ask for help when needed.

· Demonstrated ability to work in a time-sensitive environment involving patients, family members and advocates.

• **Only those lawfully authorized to work in the designated country associated with the position will be considered.**

• **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.**