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Manager of Complaints & Grievance

Job Ref: 82859
Department: CALL CENTER
Location: Downtown NYC

In Person: 2-3 days per week
Salary Range: $80,000.00 – $90,801.00


About Client

Cure Staffing, Inc, DBA Cure the Executive Edge has partnered up with one of NYC’s most prevalent and prestigious insurance providers. Our client provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, and network including primary care providers, specialists and participating clinics. Over the last three decades, our client has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life and we are excited to help them accomplish this goal. We are seeking qualified, appropriately skilled professionals who can provide reliable and professional support. All candidates must have education, experience, licenses, and certifications that are applicable and appropriate to the level of this position.

Position Overview

The Manager of Complaints and Grievances is responsible for ensuring proper handling of all same day and formal complaints received in the Call Center Department. The Manager of Complaints and Grievances must ensure that all complaints are handled efficiently and within mandated time frames as required by our regulatory/contractual obligations. They must maintain/create appropriate reports for submission to regulatory agencies. They will be responsible for conducting both internal/external investigations in order to resolve all complaints expeditiously adhering to all procedures/protocols. They will be responsible for the direct supervision of the Complaints Unit.

Job Description

  • Create & maintain all complaints reports both weekly and monthly for executive management review.
  • Oversee the complaints and grievances staff
  • Create and maintain all complaint reports for submission to our regulatory agencies on a quarterly basis.
  • Tracking and trending of all complaints for both internal/external reportingpurposes.
  • Responsible for presenting and providing all complaints for review at the Complaints & Appeals Committee meeting held quarterly.
  • Generate/maintain Complaint & Appeals Committee Meeting Minutes for distribution/review by committee and regulatory agencies when required.
  • Develop and implement complaints and grievances policies and procedures that are compliant with regulatory and operational requirements
  • Develop and implement cross functional workflows for complaints resolution from beginning to end.
  • Develop, implement, and update complaints documentation in plan content including letters, manuals, and desk aids.
  • Ensure that all complaint files and logs are maintained up todate
  • Conduct QA oversight on compliance with complaints and grievance process. QA timeliness, accuracy, letter content, tracking, reporting, and consistency.
  • Conduct and initiate internal/external investigations ensuring all complaints are handled efficiently and within appropriate and regulatory time period
  • Maintain all formal complaint acknowledgement and resolution letters
  • Review existing complaint tracking systems recommending edits/upgrades to ensure that allcall criterions is appropriately/efficiently identified and reported.
  • Ability to work collaboratively with all levels and departments within the organization
  • Ensure that all Call Center Department personnel are being properly in-serviced/trained on proper handling and identification of all complaints
  • Conduct and assist with all special projects
  • Other duties as assigned by Call Center Management

Minimum Qualifications

  • Bachelor’s Degree required; Master’s degree preferred.
  • Minimum 5 years’ experience in a managed care plan including experience managing complaints and grievances
  • Health plan operational experience including Customer Services

Professional Competencies

  • Integrity and Trust
  • Customer Focus
  • Functional/Technical skills
  • Excellent verbal and written communication skills.

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