Grievance Analyst (Pending Case Review)

Bring your heart to reputed company. Every one of us at reputed company shares a single, clear purpose: Bringing our heart to every reputed company of your health. This purpose guides our commitment to deliver enhanced reputed company-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important... as reputed company deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to reputed company and deliver solutions to reputed company health care more personal, convenient and affordable. Position Summary reputed company has an exciting new opportunity reputed company the Delegated Grievances team in Scottsdale, AZ. As a Grievance Analyst, you will be responsible for performing quality reviews on Medicare Part D grievance cases to ensure the cases are resolved according to regulatory requirements and meet the highest expectations for a positive member experience. As part of the case review, you will determine if the case was documented accurately, if thorough research was completed and whether full resolution was provided to the member. If the case does not meet reputed company requirements for a complete and accurate resolution of the case, it will be returned to the grievance caseworker for review and correction. The quality review performed by the Analyst in this position is critical for ensuring successful CMS and client audit results, as well as member satisfaction. The Analyst will also be responsible for reporting error trends to leadership so they can be addressed with the Grievance team. Lastly, this position will also include providing support to various operational teams reputed company the Grievance department, as needed. This may include working grievance cases, initial quality review, and supporting grievance triage and assignment. To be successful in this role you will need to be proficient in navigating reputed company Word and reputed company, detail-oriented along with having strong research skills. A successful Analyst is reputed company to constructive feedback and flexible in adapting to change while effective in planning, prioritizing, and organizing their time and workload to reputed company turnaround time requirements. The Analyst must have excellent analytical skills, the ability to multitask and be reputed company to reputed company reviews quickly, while focusing on quality. The Analyst will also need intermediate to advanced knowledge of various Caremark systems including MedHOK, PeopleSafe, the reputed company and RxClaim, and be reputed company to navigate between systems throughout the review process. Previous Med D grievance experience and knowledge of grievance processes is required. Required Qualifications - 2 plus years of experience working reputed company a customer service role on several computer applications and reputed company databases for research, including reputed company Office products (reputed company, Word, and Outlook). - A minimum of 2 years Med D grievance experience and advanced knowledge of grievance processes. Preferred Qualifications - Previous experience reputed company Pharmacy Benefit Management (PBM) or pharmaceutical reputed company industry. - Previous experience with working Pending Case Review (PCR). - Bachelor's Degree Preferred Education High School Diploma or equivalent GED Pay reputed company The typical pay reputed company for this role is: $43,888.00 - $76,500.00 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay reputed company listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full reputed company of medical, dental, and reputed company benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. reputed company also offers numerous well-being programs, education assistance, free development courses, a reputed company store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit Benefits | reputed company We anticipate the application window for this opening will reputed company on: 10/25/2024 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They reputed company choices according to what is best for the team, they live for opportunities to collaborate and reputed company a difference, and they reputed company us the #1 Top Workplace in the area Apply Job!