Position: Client Grievance Specialist
The Client Grievance Specialist supports inter-departmental functions to provide optimal member experience. Under the direction of the Compliance Manager, the Client Grievance Specialist is responsible for the centralized intake, logging, triage, and delegation process for all member grievances and appeals sent to Monogram Health.
Roles and Responsibilities
- Process grievances/appeals by prioritizing, evaluating, and investigating the member or provider concerns consisting of gathering pertinent information by researching internal applications, reviewing call records, and call recordings
- Collaborates with Field and Care Center management by communicating through email, phone, and video conferencing to problem-solve and find solutions to member concerns
- Identify the root cause of the grievance and escalate findings to Field and Care Center management to issue coaching; follow-up to ensure completion in a timely manner
- Performs service recovery outreaches on health plan members following a grievance/appeal; maintains a polite and professional demeanor by demonstrating empathy and support in acknowledging their concern
- Adhere to health plan reporting metric requirements on grievances/appeals to ensure deadlines are met
- Escalates potential liabilities and trends to leadership
- Daily management of internal trackers by updating records in a timely and organized fashion
- Assist with weekly, monthly, and quarterly reporting of grievances/appeals
- Manage grievances according to the Centers for Medicare and Medicaid (CMS) standards
- Perform related or additional duties as assigned
Position Requirements
- Bachelor's Degree or equivalent combination of education and related experience, required
- 1-3 years of relevant experience, required
- 1 year of experience in any of the following areas: Grievances and Appeals, Claims, Regulatory Compliance, Customer Service, or related fields, required
- Proficient knowledge of Microsoft applications (Word, Excel, and Outlook)
Benefits
- Opportunity to work in a dynamic, fast-paced and innovative value-based provider organization that is transforming the delivery of kidney care
- Competitive salary
- Comprehensive medical, dental, vision and life insurance
- Flexible paid leave and vacation policy
- 401(k) plan with matching contributions
About Monogram Health
Monogram Health is a next-generation, value-based chronic condition risk provider serving patients living with chronic kidney and end-stage renal disease and their related metabolic disorders. Monogram seeks to fill systemic gaps and transform the way nephrology, primary care and chronic condition treatment are delivered. Monogram’s innovative, in-home approach utilizes a national nephrology practice powered by a suite of technology-enabled clinical services, including case and disease management, utilization management and review, and medication therapy management services that improve health outcomes while lowering medical costs across the healthcare continuum. By focusing on increasing access to evidence-based care pathways and addressing social determinants of health, Monogram has emerged as an industry leader in championing greater health equity and improving health outcomes for individuals with chronic kidney and end-stage renal disease
At Monogram Health we believe in fostering an inclusive environment in which employees feel encouraged to share their unique perspectives, leverage their strengths, and act authentically. We know that diverse teams are strong teams, and welcome those from all backgrounds and varying experiences.
