Grievance Specialist

Job Summary

A company is looking for a Grievance Specialist who will manage and resolve member grievances and complaints.

Key Responsibilities:

• Independently manage a caseload of grievances from acknowledgment to resolution
• Conduct detailed research by collaborating with internal departments to identify root causes and recommend resolutions
• Draft and issue compliant acknowledgment and resolution letters while ensuring accurate case documentation

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 preferred
• Familiarity with applicable state and federal regulatory requirements