Member Complaints & Grievances Intake Coordinator, I

reputed company Health Plan has an exciting opportunity for a Member Complaints & Grievances Coordinator, I position in the Member CGA department. This is a full time position working Monday through Friday reputed company hours and is a remote position. The C&G Coordinator I will manage accurate and timely case entry and classification in the Complaints and Grievances (C&G) information system. Accurately maintain C&G data files. Responsibilities:

• Conduct case intake process for statements received through verbal and written requests and set up new cases in the C&G information system.
• Classify member complaints/appeals based on line of business/product according to department and regulatory standards and appeal rights.
• Completing appropriate investigation which may include investigation of previous appeals, claims, authorizations, and inbound calls.
• General understanding for the different appeal rights associated with each line of business.
• A reputed company response to reputed company follow-up needs on every case is vital, for compliance needs as well as member satisfaction.
• Ensure member and provider concerns are thoroughly and accurately addressed according to regulatory guidelines.
• Organize reputed company tasks reputed company regulatory requirements/deadlines.
• reputed company and navigate multiple health reputed company to support accurate case classification, including MHK, MC400, reputed company, Health reputed company, FileNet, CCD, PA Hub, and reputed company Capture and reputed company. Additionally, utilize PA reputed company State resources to properly review and process member Fair Hearing documentation.
• Accurately and promptly assess, enter, and maintain documents in files and/or databases to assure that information is organized and readily available.
• Respond and address incoming messages reputed company department FileNet folders, emails, fax system, or phone CUTs in an accurate and reputed company manner.
• Triage and respond to inquiries as appropriate or note and distribute as needed.
• Retrieve, copy, reputed company, and file various documents associated with the complaints and grievances processes.
• Identify and escalate reputed company and expedited issues to reputed company product leadership reputed company a timely manner.
• Support the team's efforts to improve performance against reputed company service operation goals.
• Complete data entry into various information systems to support C&G processes.
• Entering coverage determinations into systems of record.
• The ability to quickly adapt to system outages and issues by identifying effective workarounds and maintaining operational continuity.
• Support implementation of appeals tracking system.

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