Job Description

Job title:          Investigation/Review of Complaints & Grievances Associate (10448588)

Location:         Philadelphia, PA 19113

Client:             Healthcare

Duration:        3+ months contract position

Pay Rate:         $23 per hour on w2

Hours Per Week:         40.00 

JOB DESCRIPTION:

·         The Grievance Coordinator is responsible for ensuring the standard metrics of 100% is achieved within the Plans contractual agreement. 

·         This is performed by generating standard reports from Macess/EXP and engaging internal departments for follow-up to outstanding grievance related issues.  

·         The Grievance Coordinator will attend all standard meetings associated with complaints & grievances reviews and confirm that all problems, complaints and grievances, presented by Plan members or their representatives are resolved in accordance with established policies and procedures as well as, NCQA and Federal/State guidelines. In addition, the Grievance Coordinator is responsible for providing statistical root cause analysis on a quarterly basis for the Plan and Department of Health Services.   

·         The Grievance Coordinator will also act in the capacity of the Supervisor, when they are out of the office or unavailable. These functions will include review and triaging all work activities completed by the grievance associate.

Skills:

·         3-5 years investigation/review of complaints & grievances    

·         Prior experience in a highly regulated industry required.

·         Strong understanding of inventory management

·         Sound knowledge of strong telephone soft skills.

·         Proficiency with Microsoft Office skills including Word, Excel and Outlook

·         Experience handling escalated call issues that may result in State complaints

·         Previous experience as a Team Lead and/or Supervisor

·         Experience in overseeing and development of training & material 

·         Ability to work both independently and in a team environment

·         Demonstrated problem-solving and decision-making skills.

·         Excellent Verbal and Written communication skills.

EDUCATION

High School/GED

Associate degree – highly preferred

Company Description

Della Infotech Inc is in staffing business for five years. Over the years, we have placed hundreds of candidates to various temp and permanent positions with our 50+ happy clients all over US and Canada including Fortune 500 corporations.