Note: The job is a remote job and is open to candidates in USA. Convey Health Solutions is a fast-growing healthcare organization offering a temporary role for a Customer Grievance Analyst. The Analyst is responsible for researching and resolving customer complaints in accordance with CMS guidelines, focusing on root cause analysis and effective communication with customers.
Responsibilities
- Accurately identify and document customer complaints based upon notes received from customer service, correspondence received from the customer and/or review of the recorded customer interaction
- Utilize knowledge of program processes and systems to research assigned grievance cases in their entirety to identify the cause of received complaints and identify a resolution appropriate to the situation
- Convey the identified resolution to the customer or his/her representative either in writing or verbally
- Identify and document the resolution and root cause for any assigned grievances including accurate
- Report identified trends in complaints and root causes to management for escalation
- Prepare reports as requested by management
- Display positive demeanor, technical accuracy, and conformity to company policies
- Understand CMS Guidance and ensure that communication is in accordance with CMS Guidance
- Ensure HIPAA regulations are maintained within the immediate environment
- Documentation is detailed and concise as it pertains to member records
- Identifies need for outbound calls for purposes of validating information and addresses and conducts member outreach
- Communicate with coworkers, management, staff, customers, and others in a courteous and professional manner
- Conform with and abide by all regulations, policies, work procedures and instructions
- Respond promptly when replying to correspondence and faxes
- Act, dress, and behave in a professional manner to reflect a positive image of the company
Skills
- High School Diploma is required
- Three to five years' customer service experience in a federally regulated or insurance related field is a plus
- Excellent writing skills
- Excellent written, verbal, and interpersonal communication skills
- Excellent organizational skills and attention to detail
- Excellent documentation skills
- Ability to provide clear and accurate information through multiple media
- Ability to manage open requests and follow up when necessary without outside direction
- Ability to effectively manage time with strong attention to detail
- Ability to read and interpret documents including safety rules, operating and maintenance instructions, procedure manuals and general correspondence
- Ability to write routine reports and correspondence
- Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals
- Ability to carry out instructions furnished in written, oral, or diagram form
- Ability to deal with problems involving several concrete variables in standardized situations
- Ability to politely, tactfully and firmly interact with a wide range of people and personalities
- Ability to work in an environment with potential interruptions
- Must be able to operate computer, calculator, copier, fax machine, phone and other office equipment
- This position requires the ability to work with a personal computer in a Windows environment
- Must possess strong familiarity with office software including Word, Excel, PowerPoint, and Outlook
- Associate's or Bachelor's Degree preferred
- Medicare: 1 year (Preferred)
Company Overview