"Alerted.org

Job Description

Job Title: OTC Grievance Analyst

Position Summary:

Grievance Analysts are empowered to provide each Customer with the best experience possible through the clear and timely resolution of the concerns and feedback members share.

A keen eye for details, passion for serving the unique needs of the Medicare population, and critical-thinking and communication skills will be the keys to success for the successful candidates in this mission-critical role.

Essential Duties and Responsibilities

+ Research, investigate, and resolve grievances for all products in accordance with regulatory requirements, internal policies and claims events

+ Identify correct resource and reroute inappropriate work items that do not meet complaint and grievance criteria

+ Ability to translate complex information into a simple message on assigned grievance cases including written and verbal communication to the appropriate individuals including the member, clients, and internal department(s)

+ Analyzes and renders determinations on assigned grievances and completion of the respective written communication documents to support the determination

+ Escalate transactions that are not correctable to a Team Leaders.

+ Prepare other reports as requested by management.

Education and Experience

+ Minimum Associate's degree, Bachelors preferred or High School Diploma with 3+ years of Customer Service experience

+ Preferred one or more years of experience working with Pharmacy Benefit Manager (PBM), Experience in Health Plan, managed care plan or Part D/Prescription Drug plan sponsor.

+ Comfortable working in fast paced environment with the ability to work with tight deadlines.

+ Comfortable performing repetitive tasks at times.

+ Strong verbal and written communication skills and strong problem-solving and investigational abilities

+ Comfort level with technology and aptitude for learning new software.

+ Ability to meet demands of a high paced environment with tight turnaround times.

Other Duties and Responsibilities

+ Assist the member services department when high call volumes occur.

+ Responsible for compliance with all federal, state and local laws, rules and regulations affecting Company.

+ Responsible for participating in quality assurance, compliance and in-service and continuing education activities as requested by Company.

+ Responsible for performing other duties and responsibilities as required.

Skills, Knowledge and Abilities

+ Superior written communication skills.

+ Advanced comfort level with technology.

+ Ability to translate and articulate complicated and multi-layered information into simple messages.

+ Analytic mind that enjoys putting together clues found throughout a variety of information sources.

+ Adherence to following internal policy.

+ Shift priorities with little advance notice.

+ Interest in continuously expanding the scope of your expertise through experience and training activities.

+ Must be able to work collaboratively within a Team environment with a senior member of your Team.

About Us

About UsConvey Health Solutions, together with Pareto Intelligence™, delivers a powerful combination of purpose-built technology, advanced analytics, and expert services to help health plans thrive in a complex, post--Affordable Care Act environment.As a trusted partner to Medicare and commercial payers, we provide scalable, compliant solutions that span the entire member lifecycle--from enrollment and billing to risk adjustment, Stars performance, and member engagement. Pareto's deep analytics and financial intelligence complement Convey's operational expertise, enabling our clients to improve performance, reduce costs, and create better healthcare experiences for millions of Americans--especially seniors and vulnerable populations.Together, we help health plans scale smarter, grow stronger, and make healthcare work better for the people who need it most. Learn more at http://www.ConveyHealthSolutions.com