Member Grievance Coordinator

The vision of Colorado Access is to have healthy communities transformed by the care that people want at a cost we can all afford. Our mission is to partner with communities and empower people through access to quality, affordable care.

Why should you consider a career with Colorado Access?

• Find work/life balance: We offer PTO, floating holidays, nine company paid holidays, a hybrid work environment, an Employee Assistance Program and a 401K.
• Be a part of something bigger and make an impact: We serve the underserved and most vulnerable populations in our community through access to quality and affordable health care.
• Sharpen your skills, learn, and grow: We support your continued development through tuition reimbursement, leadership training, promotion opportunities, performance evaluations, employee recognition, and a language pay stipend.

What you will do:

• Promptly responds to member grievances, while demonstrating compassion, empathy, respect and customer service.
• Maintains record of activities through comprehensive documentation within department databases.
• Responsible for logging, tracking, monitoring, resolving, auditing and reporting of member grievances.
• Gathers additional information, researches, investigates to facilitate resolution of grievances.
• Ensure grievances are resolved in a professional, expeditious manner, and within contractual and regulatory time limits.
• Identifies potential quality of care issues and directs cases to the Quality Management Department for review as needed.
• Writes and sends member response letters, and other general correspondence, related to grievances, by following department guidelines, demonstrating appropriateness and utilizing approved template letters.
• Recommends and manages improvements to automate processes, improve customer satisfaction and increase efficiencies.
• Provides internal and external training and education on the Member Grievance process.
• Ensures the grievance resolution process and daily activities comply with corporate policy and procedure, ADM 203.
• Monitors grievances for trends and recommends appropriate action.
• Ensures grievance calls are answered from the grievance phone queue and follows department and company standards.

What you will bring:

• Education: High School diploma or equivalent required, or an equivalent combination of education and experience. A bachelor’s degree in Healthcare Administration preferred.
• Experience: Requires two years of health care experience. Prefer customer service, eligibility and enrollment, grievance, behavioral healthcare or project management experience.
• Knowledge, Skills, and Abilities: Knowledge of health care, Colorado Medicaid and managed care preferred. Must have excellent written and verbal communication skills. Must have strong time management skills, strong interpersonal skills and a strong working knowledge of database and spreadsheet programs, particularly Access.

Together we will be: an innovative and collaborative team who supports each other, the employees and vision of the company to reach our goals individually, together and as an organization.

Pay, Perks and Benefits at Colorado Access:

• Medical, dental, vision insurance that starts the first day of the month following start date.
• Supplemental insurance such as critical illness and accidental injury.
• Health care and dependent care flexible spending account options.
• Employer-paid basic life insurance and AD&D (employee, spouse and dependent).
• Short-term and long-term disability coverage.
• Voluntary life insurance (employee, spouse, dependent).
• Paid time off
• Retirement plan
• Tuition reimbursement (based on eligibility).
• Annual bonus program (based on eligibility, requirements and performance).

Where you will work: This position will be a hybrid model work environment, a blend of ‘In-Office’ and ‘Remote.’

Colorado Access is committed to providing equal opportunities to all people regardless of race, color, national origin, age, sex, genetic information, religion, pregnancy, disability, sexual orientation, veteran status or any other status protected by applicable law.