Grievance Specialist

Managing and resolving member-initiated grievances, the full-time remote Grievance Specialist will advocate for Healthfirst members by conducting thorough investigations and ensuring compliant resolutions across various product lines, including Medicare and Medicaid. Key Responsibilities Independently manage a caseload of grievances through the full case lifecycle, from acknowledgment to resolution Conduct detailed research by collaborating with internal departments to identify root causes and recommend resolutions Draft and issue clear and compliant acknowledgment and resolution letters to members Required Qualifications HS Diploma or GED from an accredited institution Understanding of utilization management processes and their impact on member access to care Proficient in Microsoft Office Suite, including Excel and case tracking systems 2+ years of experience in managed care, member services, or healthcare grievances resolution Familiarity with applicable state and federal regulatory requirements, such as CMS regulations