Complaints and Grievance Coordinator

Job Summary: 

SafeRide Health is seeking an experienced Complaints and Grievance Coordinator responsible for processing complaints and grievances, consisting of member grievances, appeals, and provider disputes. This role ensures that cases are resolved by client-specific requirements across all lines of business.

Primary Responsibilities

Maintain contractual compliance and customer satisfaction

Ensure that all assigned complaints and grievances are completed by the deadline and other contractual requirements

Respond to Comment Letters and client inquiries and requests

Ensure interactions remain positive and professional with all persons with whom you and the Complaints and Grievance Team interact in the course of your work, both internally and externally

Researching the details and history of a case and creating a clear timeline of events

Communicating, both orally and in writing, with members and providers as needed

Updating members and providers regarding the progress of active and open cases

Requesting, reviewing, sorting, and preparing data related to complaints and grievances

Working with relevant departments to complete all necessary follow-up and research

Complaint and grievance escalations

Interdepartmental and Client Communication

Provide daily, weekly and monthly complaint and grievance updates to leadership

Recommend solutions and work with internal department leadership to ensure problems are corrected, and departments are advised of corrective measures to prevent recurrences

Provide complaint and grievance data to leadership regarding provider complaint and grievance trends

Other duties as assigned

Required Education and Experience:

Minimum High school diploma or equivalent

Minimum one (1) year in grievance and appeals processing

Minimum one (1) year in an inbound call center environment

Preferred Education and Experience

Experience with Medicaid, Medicare, and NEMT guidelines

Associate’s degree in relevant discipline

Knowledge of health insurance programs and benefits

Skills

Customer-oriented with the ability to address customers’ needs while following company procedures.

Outstanding problem-solving skills and ability to use soft skills in a high-stress environment

Strong analytical skills and the ability to use thinking and logic to solve everyday issues

Personable, with solid leadership and mentoring skills

Strong communication skills (both verbal and written) and demonstrated ability to communicate, present, and influence effectively in person, via email, and over the phone

Ability to meet contractual reporting requirements and deadlines

Ability to adapt to unforeseen circumstances quickly

Ability to respond to sensitive or complex issues with tact and sensitivity

Proficiency in listening and problem-solving skills

Ability to establish and maintain effective working relationships with members, coworkers, providers, and individuals of varying socio-economic and cultural backgrounds and with special needs populations

Ability to effectively, clearly, and independently document, summarize and resolve member’s concerns and inquiries

About Us: 

SafeRide Health is a technology and services company dedicated to reducing barriers to care by improving the delivery of non-emergency medical transportation to people across America. SafeRide Health leverages proprietary technology and a nationwide network of vetted transportation providers to give payers and health systems a more intelligent way to deliver cost-effective, on-demand transportation while improving the patient experience. SafeRide serves the largest Medicare Advantage, Medicaid, and provider programs in the country. Learn more at www.saferidehealth.com.