Description:Under general supervision interacts directly with members who request to file a grievance with the Health Plan. The incumbent will interact directly with management staff, other KHS departments, providers, and the grievance team to investigate and facilitate timely resolution of all grievances by Plan Members. The incumbent will have daily and extensive contact with members to resolve issues, interpret policies/procedures, benefits, respond to requests for service, and with providers to obtain information/documentation necessary to resolve member grievances.
Requirements: Typing certificate of 45 wpm, required within one year of issuance. Two (2) or more years of recent experience in customer service related field with a high degree of problem solving and decision making that include adherence to time frames. High phone volume inquiry experiences a plus. Excellent written and verbal communication skills are required. Excellent customer service and telephone techniques and etiquette. Health Maintenance Organizations (HMO) desirable. Work under pressure; prioritize work; analyze situations accurately and take appropriate actions; work independently and manage multi-task responsibilities; be willing and able to assist and educate the member; intervene effectively in crisis situation on behalf of an upset, distraught, dissatisfied, confused or angry member; solve complex and comprehensive problems; organize and set priorities; adhere to state and federal timelines; have excellent communication skills both written and verbal and work in a rapidly evolving work environment.
High School Diploma from an accredited school or Equivalency Degree plus 1 year of college. Two years’ experience in a customer service organization or related field may be substituted for one year of college. Spanish speaking preferred. Possession of valid driver’s license and proof of State required auto liability insurance. Required Travel Up to 15%
We have an excellent benefit package to include: health care, dental, life, 457b and 401a plan, and other supplemental benefits. As a condition of employment, a satisfactory drug test and background check are required. E.O.E.