Grievance Associate

Your career starts now. We are looking for the next generation of health care leaders.

At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to connect with you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Responsibilities:

Working with the Operations Supervisor or Grievance Coordinator, the Grievance Associate is responsible for ensuring all problems, complaints and grievances, presented by Plan members or their representatives are resolved in accordance with established policies and procedures as well as, NCQA and Federal/State guidelines. Under the supervision of the Operations Supervisor or Grievance Coordinator, the Grievance Associate acts as a member advocate and communicates with medical facility administrators, providers, physicians and all applicable AMFC departments to interpret and enhance understanding of the Plan's policies and procedures relative to complaints and grievances. The Grievance Associate is responsible for accurately documenting, in the appropriate computer system, all correspondence associated with the grievance. The Grievance Associate will thoroughly research questions and issues in order to provide an accurate explanation. The Grievance associate tracks and reports turnaround time and keeps abreast of all cases to ensure that the 30-day time limit for case resolution is met for 100% of all grievances. The associate will provide Complaint/Grievance training for the Plan's staff in the base unit and all supporting departments. The Grievance Associate will perform other related duties and projects as assigned.

Education/ Experience:

• High School/GED

  Associate's Degree (preferred)

• 1 to 3 years previous experience in direct contact with members in relation to any complaints and/or grievances
• Sound knowledge of strong telephone soft skills
• Prior experience in highly regulated inventory
• Experience with Contact Center and Workforce Management technology (scheduling, adherence, quality monitoring)
• Excellent Verbal and Written communication skills
• Microsoft Office skills including Word, Excel and Outlook
• Experience handling escalated calls
• Demonstrated problem-solving and decision making skills.
• Strong people skills with a focus on mentoring and coaching
• Ability to work both independently and in a team environment.

Diversity, Equity, and Inclusion

At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.