Complaints And Grievance Coordinator (Healthcare)

TL;DR

Complaints and Grievance Coordinator (Healthcare): Processing member grievances, appeals, and provider disputes to ensure contractual compliance with an accent on case research and resolution timelines. Focus on coordinating between internal departments and clients to implement corrective measures and prevent recurrences.

Location: Hybrid (San Antonio, Texas)

Company

A technology and services company improving the delivery of non-emergency medical transportation (NEMT) for Medicare and Medicaid programs across America.

What you will do

• Process member grievances, appeals, and provider disputes according to client-specific requirements.
• Conduct research on case history to create detailed timelines and resolve disputes.
• Maintain contractual compliance and ensure all assigned cases are completed by the deadline.
• Communicate with members, providers, and internal departments to resolve escalations.
• Prepare and provide daily, weekly, and monthly grievance trend reports to leadership.
• Recommend corrective measures to internal leadership to prevent the recurrence of reported problems.

Requirements

• Must be based in San Antonio, Texas (Hybrid)
• Minimum one year of experience in grievance and appeals processing.
• Minimum one year of experience in an inbound call center environment.
• High school diploma or equivalent.

Nice to have

• Experience with Medicaid, Medicare, and NEMT guidelines.
• Associate’s degree in a relevant discipline.
• Knowledge of health insurance programs and benefits.

Culture & Benefits

• Full-time corporate employment.
• Mission-driven work reducing barriers to care for special needs populations.
• Collaborative environment utilizing proprietary technology to improve patient experience.