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Corporate Functions & Operations WellCare - Appeals & Grievances Careers

Grievance Coordinator Job

Full Job Title: Grievance Coordinator

Job Number: 1803696

Location: Oahu, HI

Date Posted: 5-25-2018

Responds to member and provider inquiries (phone, written or walk in) regarding all aspects of WellCare business, including claims, in a professional, timely, accurate and caring manner while consistently meeting all guidelines.

REPORTS TO: DIRECTOR, STATE REGULATORY AFFAIRS
DEPARTMENT: HI-OPERATIONS-CUSTOMER SERVICE STATE
POSITION LOCATION: KAPOLEI, HI 96707
Essential Functions:
  • Responds to member, provider and other inquiries via telephone, correspondence or lobby walk-in while meeting all corporate guidelines and performance standards.
  • Demonstrates appropriate customer-care skills such as empathy, active listening, courtesy, politeness, helpfulness and other skills as identified.
  • Records, investigates and resolves member complaints as detailed in the Grievance Procedure narrative.
  • Assists in the education of new members and in the re-education of existing members regarding health plan procedures.
  • Track grievance case by line of business for compliance and review.
  • Assist in resolving member and provider complaints
  • Makes decisions that are consistent with the concept of a win-win-win for members, associates and WellCare.
  • Demonstrates based behaviors such as initiative, accountability and value.
  • Performs skills necessary to create a high-quality customer experience, as reflected through acceptable quality audit score and productivity.
Education:
  • High School Diploma is required
  • Associates degree is preferred
Experience:
  • 1-3 years experience within a call center or customer service environment is required
  • 1 year Grievance experience is preferred
  • Experience within a health care company is preferred
Licenses/Certifications:
  • Customer service, quality or training certifications is preferred
Special Skills (e.g. 2nd language):
  • Written and verbal communication skills and an ability to work with people from diverse backgrounds
  • Ability to multi-task, good organizational and time management skills
  • Ability to act on feedback provided by showing ownership of his or her own development
  • Ability to read, analyzes, and interprets verbal and written instructions
  • Ability to write business correspondence
  • Ability to effectively present information and respond to questions from members
  • Ability to define problems collects data, establish facts and draw valid conclusions
  • Seeks to build trust, respect and credibility with all partners through full, honest, consistent, and coordinated communication
Technical Skills/Requirements:
  • Knowledge of email systems such as Microsoft Outlook sufficient to communicate with both internal and external contacts
  • Knowledge of MS Word and/or MS Excel to sufficiently enter data

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Last Updated On: 12/9/2015