Member Services Letter Editor - 6-Month Contract (58004)

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

MUST HAVE BACKGROUND IN:

- Writing
- Health care
- Grievance
- Appeals

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*