Member Services Letter Editor - 6-month contract (58004)

California  ‐ Onsite
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Description

Member Services Letter Editor

Duration: 6-month contract

Location: Rancho Cucamonga, CA 91730

Job Number: 58004

Client: One of the country's largest health care and health plan providers

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 every day
  • 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

Required Education, Experience, and Skills:

  • High school diploma or GED required
  • 4 year degree in education, journalism, communication or related field preferred
  • 2 years' 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
  • Extensive working knowledge of personal computers to include Windows-based software applications, MS Word, etc
  • Ability to multitask and manage time in order to perform well on long term projects while being flexible enough to assimilate short term projects on an ongoing basis
  • Must be able to work in a Labor/Management Partnership environment
  • Will work varied shifts

Preferred Experience and Skills:

  • 2 years' experience in a complex health care environment
  • Strong working knowledge of federal and state regulations, laws and accreditation standards related to health care and managed care organizations
  • Knowledge of member complaint and grievance processing
  • Strong writing skills, syntax, grammar and spelling competency
  • Editorial experience, previous writing position
  • Strong customer service, phone skills in diffusing member complaints

*As part of the application process, qualified applicants will need to edit a sample case letter which will be emailed to them*

Start date
mid-February
Duration
6 months
From
Enclipse Corp.
Published at
10.02.2015
Project ID:
848143
Contract type
Freelance
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