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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


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