Category: Computer and Mathematical Occupations
Reference: 1068942
Job Summary:
We have a 1-year contract opportunity for a Case Coordinator in Corona, CA.
Expected Shift: M-F 9:30-6pm, possible rotational Saturday based on operational needs. This position is 100% onsite.
Description:
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 the 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.
Minimum Work Experience and Qualifications:
- 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 the 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.
Preferred Work Experience and Qualifications:
- Experience in a complex health care environment preferred.
- 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 preferred.
- Competent working knowledge of KP Health Plan benefits plan/contracts/systems strongly preferred.
Educational Requirement:
- High school diploma or GED required.
- Some college preferred.
Location: Corona, California
Job Type: Contract
Salary: $21 - 24 per hour
Work Hours: 8am to 5pm
Education: High School
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