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 Research the details and history of a case and create a clear timeline of events Communicate, both orally and in writing, with members and providers as needed Update members and providers regarding the progress of active and open cases Request, review, sort, and prepare data related to complaints and grievances Work with relevant departments to complete all necessary follow-up and research Handle complaint and grievance escalations Facilitate 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 a 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 members’ concerns and inquiries #J-18808-Ljbffr SafeRide Health