Job description

GRIEVANCE AND APPEALS COORDINATOR

–Position is not eligible for sponsorship –

Health Plan of San Mateo (HPSM) seeks a full-time Grievance and Appeals Coordinator to resolve concerns from our members and their representatives. When any of our 160,000+ members are dissatisfied with the medical care they have received, or the customer service provided by HPSM or their doctor's office, they have the right to file a complaint. HPSM’s 12-person Grievance and Appeals Unit is responsible for addressing and resolving their issues as quickly as possible — and our team of Grievance and
Appeals Coordinators takes the lead in this process.

Position overview

• Speak with members and providers on the phone to gather information about cases
• Communicate with people calmly and respectfully (even when someone is not calm and respectful)
• Write letters to members that help them feel heard and offer resolutions to their concerns

Key responsibilities

• Research and document problems affecting members.
• Outreach to providers and other partners to resolve member complaints.
• Maintain detailed grievance and appeals case files in HPSM’s database
• Prepare files for appeals to regulatory agencies and regulatory audits
• Abide by grievance and appeals processes and regulatory requirements.

Requirements

These are the qualifications typically needed to succeed in this position. However, you don’t need to meet every requirement to apply.

Education and experience

• Associate’s degree in health, social sciences or humanities (preferred)
• Experience working in a call center, patient relations or other customer service position (required)
• Two years of experience working with Medi-Cal or Medicare in a managed care environment (preferred)
• Experience performing grievance and appeals processing (preferred)

Knowledge and ability

• Computer applications, including proficiency in Microsoft Office Suite
• Medicare, Medi-Cal, managed care and medical terminology (preferred)
• Work as part of a professional team as well as independently
• Thrive in a fast-paced and collaborative team environment
• Provide quality customer service at all times
• De-escalate challenging situations in which people may be upset

Salary and benefits

The starting salary range depends on the candidate’s work experience.

Excellent benefits package includes:

• HPSM-paid premiums for employee’s medical, dental and vision coverage (employee pays 10% of each dependent’s premiums)
• Fully paid life, AD&D and LTD insurance
• Retirement plan (HPSM contributes equivalent of 10% of annual compensation on top of salary)
• 13 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year
• Tuition reimbursement plan
• Employee wellness program

To apply complete an HPSM Employment Application and submit it with a resume and cover letter that includes salary expectations to careers@hpsm . org. In your cover letter, please briefly describe a challenging phone call you had with a customer and how you handled the situation. Submissions without a cover letter and salary expectations may not be considered.

Health Plan of San Mateo (HPSM) is a local community-based health plan that manages the health care of over 160,000 low-income people San Mateo County, including all its Medi-Cal eligible residents. HPSM is proud to be an Equal Opportunity Employer and an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.

Job Type: Full-time

Pay: $26.00 - $34.00 per hour

Benefits:

• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

COVID-19 considerations:
All HPSM employees MUST be residing in and working from the state of California. Employees may come into the office if they wish, or work from home. HPSM will supply work from home equipment.

Application Question(s):

• Please only apply if you are residing in the state of California.

Work Location: One location

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