Grievance Specialist Temporary

Profile

ABOUT THIS TEMP POSITION
This is a temporary position and the length of assignment is estimated to go from 10/2022 to 12/31/2022. The length of the assignment is always dependent on business need and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with.
WHAT YOU'LL BE RESPONSIBLE FOR
Reporting to the Grievance Supervisor, you will support the administration and resolution of medium complexity cases in support of the Alliance Grievance function. You will assist Grievance and Quality Leadership with daily operations. You will participate in departmental and cross departmental trainings, workgroups, and operational improvement activities.
WHAT YOU'LL NEED TO BE SUCCESSFUL
Knowledge of:
The principles and practices of managed healthcare, healthcare coverage and benefit structures, principles of coordination of benefits and medical billing
Title 22 and Title 28 utilization management and grievance regulations
The diverse needs of the Medi-Cal population
The principles and practices of customer service
Ability to:
Identify issues, conduct research and investigations, gather and analyze information, reach logical and sound conclusions, and offer recommendations and potential consequences
Interpret legal, regulatory and contractual language, policies, procedures and guidelines, and legislative and regulatory directives
Prepare reports, correspondence and other program documents
Quickly learn and competently navigate computer systems, including internal tracking systems
Education and Experience:
Bachelor’s degree in Health, Social Science, or a related field
Minimum of three years of experience in a managed health care setting, health plan or provider office performing work related to processing provider claims, including a minimum of one year of experience administering provider disputes or member appeals and grievances (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying
OTHER DETAILS
While this position is connected to one of our Alliance offices, we are in hybrid telecommute work environment right now and we anticipate that the interview process will take place remotely.
Our Alliance office locations have officially re-opened as of May 2, 2022 and while some employees may work in full-time telecommute schedules, attendance at quarterly company-wide events or department meetings will be expected.
Based on the nature of work, this position may require onsite presence, which is dependent on business need. Details about this can be reviewed during the interview process
This is a temporary position, and does not provide the benefits that are listed below (it is standard language from our regular job posts and cannot be altered or removed)
COVID-19 Vaccine Requirement:
This position requires staff to be fully vaccinated and boosted upon their start date as a condition of employment. Proof of vaccination must be submitted at time of hire. Fully vaccinated and boosted is defined as receipt of the second dose in a 2-dose series (Pfizer & Moderna vaccines) OR receipt of a single-dose vaccine (Johnson & Johnson); AND receipt of the booster (if eligible); AND a 2-week period having passed since the administration of the last vaccine dose.
Additionally, all positions at the Alliance are required to meet these minimum qualifications.
OUR BENEFITS
Medical, Dental and Vision Plans
Ample Paid Time Off
11 Paid Holidays per year
401(a) Retirement Plan
457 Deferred Compensation Plan
Robust Health and Wellness Program
EV Charging Stations
And many more
ABOUT US
We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
Join us at **MEMBERS ONLY**SIGN UP NOW***. (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Merced, Monterey and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet
At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

Company info

Sign Up Now - WashingtondcCrossing.com