Description

The Case Manager - Appeal and Grievance will play a crucial role in assisting with member complaints and grievances within a healthcare environment. This position is remote but requires an initial two weeks of onsite training. The ideal candidate will have strong writing and customer service skills, with a focus on handling complex cases effectively.

Company Culture and Environment

The company fosters a supportive and collaborative work environment, emphasizing the importance of customer service and effective communication. Employees are expected to be adaptable and committed to delivering quality care to members.

Career Growth and Development Opportunities

The role offers opportunities for professional growth within the healthcare sector, as the company values employee development and encourages advancement within the organization.

Detailed Benefits and Perks

• Health insurance (medical, dental, vision)
• 401(k) plan
• Paid sick leave (depending on work location)
• Opportunities for overtime (up to 5 hours/week)
• Telecommuting options available after initial training
• Equipment provided for remote work (Aruba router, CPU/laptop, monitors)

Compensation and Benefits

• Pay range: \(25 - \)30 per hour

Why you should apply for this position today

This position provides a unique opportunity to contribute to the healthcare field while working remotely. By joining our team, you will help make a difference in the lives of members managing their health plans, all while enjoying a flexible work environment.

Skills

• Strong customer service and communication skills
• Proficient in Microsoft Excel and Word
• Ability to write detailed letters and documentation
• Competent in processing member complaints and grievances
• Knowledge of client Health Plan benefits and systems preferred

Responsibilities

• Manage member complaints and grievance processing
• Communicate effectively with members over the phone
• Write detailed documentation and letters regarding cases
• Collaborate with team members to resolve complex issues
• Maintain knowledge of healthcare policies and procedures

Qualifications

• Minimum of 4 years of experience in healthcare
• At least 6 years of customer service experience
• Strong writing skills and ability to communicate clearly

Education Requirements

• High school diploma or GED required
• Bachelor’s degree preferred

Education Requirements Credential Category

• High School Diploma or equivalent is the minimum requirement; Bachelor’s degree is preferred.

Experience Requirements

• Minimum of 7 years of total work experience, with specific emphasis on healthcare sector experience.
• Experience in member complaint and grievance processing is highly regarded.

Why work in San Diego, CA

San Diego offers a beautiful coastal environment with a mild climate, allowing for a great work-life balance. The city is known for its vibrant culture, recreational opportunities, and diverse culinary scene, making it an ideal location for both personal and professional growth.