Grievance Coordinator

Your Future is our Future At Lumeris, we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact. We're excited to consider every qualified candidate authorized to work in the United States, although we are unable to sponsor visas for this role at this time. Position: Grievance Coordinator Position Summary: Works an important part of the Medicare Grievances Program, which is the heartbeat of Plan operations and a direct insight to member experience. Reviews and investigates member complaints and works with internal and external partners to reach mitigation and resolution for the member. Handles each grievance in accordance with organizational and regulatory guidelines. Job Description: Primary Responsibilities Conducts thorough investigations into member complaints, identifies all issues or components of the grievance, and achieves resolution through action and education to the member. Utilizes senior resources as needed. Conducts rigorous root cause analysis on escalated member grievances, using structured diagnostic techniques to identify underlying system, plan, or provider issues. Researches, gathers information and evidence, and conducts timely outreach with members, providers, internal and external partners, reviews issues, and assesses appropriate resolution. Documents investigation as an accurate and complete chronological record of actions taken, communication and information obtained, and member resolution and notification for each grievance. Ensures grievance resolution reflects the member's complaint and accurately and completely addresses all components of the complaint. Keeps track of several cases simultaneously while making sure each member gets the attention they deserve in a high-volume, high-touch environment. Creates and maintains good rapport and collaborates effectively in all areas of the organization. Recognizes urgent and sensitive issues/incidents and escalates in a timely manner to facilitate appropriate and timely response. Communicates the status of assignments in weekly internal meetings for discussion and direction. Demonstrates sufficient knowledge of complaint and understanding of related plan processes or functions to adequately articulate issue and resolution. Qualifications Bachelors degree or equivalent 1+ years of related work experience or the knowledge, skills, and abilities to succeed in the role Ability to maintain high ethical standards Good critical thinking and problem-solving skills Ability to multi-task and operate effectively in both remote and in-person settings Skilled problem-solver with the ability to take on basic problems and achieve a solution within a reasonable amount of time Good investigatory skills with ability to organize, review, and effectively assess risk and appropriate response Ability to remain fair and identify facts Organizational skills for prioritizing tasks to meet set deadlines Good communication and interpersonal skills with the ability to interact at all levels Good customer service skills Working Conditions While performing the duties of this job, the employee works in normal office working conditions. #LI-Remote Pay Transparency: Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. In addition to the base salary, certain roles may qualify for a performance-based incentive and/or equity, with eligibility depending on the position. These rewards are based on a combination of company performance and individual achievements. The hiring range for this position is: $44,100.00-$54,825.00 Benefits of working at Lumeris Medical, Vision and Dental Plans Tax-Advantage Savings Accounts (FSA & HSA) Life Insurance and Disability Insurance Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days) Employee Assistance Program 401k with company match Employee Resource Groups Employee Discount Program Learning and Development Opportunities And much more... Be part of a team that is changing healthcare! Member Facing Position: Yes- Member or Patient Facing Position Drug Screen Requirement: No MVR Required: No Credit Check Required: No Location: Remote, USA Time Type: Full time Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment. Disclaimer: The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individual with disabilities to perform the essential job duties and responsibilities. Lumeris is an EEO/AA employer M/F/V/D.