Lumeris Grievance Specialist (remote) in St. Louis, Missouri
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Grievance Specialist (remote)
The Grievances Specialist is an important part of the Medicare Grievances Program, which is the heartbeat of Plan operations and a direct insight to member experience. We are passionate about providing a positive experience for our members and ensuring they feel value and heard. The Grievances Specialist is responsible to analyzing and investigating member complaints and working with internal and external partners to reach mitigation and resolution for the member. The Specialist will handle each grievance in accordance with organizational and regulatory guidelines.
This position will be a remote position.
The ideal candidate is a problem-solver and go-getter who loves a challenge and gets a kick out of going the extra mile to make someone’s day. The individual must be curious and can identify issues and solutions for member complaints. This person must be flexible and have the ability to operate with limited information and adapt to varying scenarios and environments. This is a high-volume, high-touch environment, and that can mean keeping track of several cases simultaneously while making sure each member gets the attention they deserve. Our passion and commitment to the member translates into personal and team accountability for how we represent our health plans and work to resolve issues and drive member satisfaction.
Conduct thorough investigations into member complaints to identify all issues or components of the grievance and achieve resolution through action and education to the member
Research, gather information and evidence, conduct timely outreach with members, providers, internal and external partners to be able analyze issues and assess appropriate resolution.
Document investigation – an accurate and complete chronological record of actions taken, communication and information obtained; and member resolution and notification for each grievance.
Ensure grievance resolution reflects the member’s complaint and accurately and completely addresses all components of the complaint
Work with departments and subject matter experts to identify potential for broader impact and appropriate corrective actions.
Build and maintain good rapport and work effectively with individuals in all areas of the Company.
Recognize urgent and sensitive issues/incidents and escalate to management in a timely manner to facilitate appropriate and timely response.
Communicate the status of assignments to Manager and team in weekly internal meetings for discussion and decision-making.
Demonstrate sufficient knowledge of complaint and understanding of related plan processes or functions to adequately articulate issue and resolution,
Proactively identify areas of improvement for self and the department, and participate in the development and completion of individual and departmental objectives and performance improvement initiatives.
High School diploma or equivalent required, with Associate degree preferred
At least two years of related work experience
Energetic, persistent, and forward thinking with high ethical and professional standards
Must have strong critical thinking skills
Excellent writing skills
Strong logical, analytical, critical thinking, and problem-solving skills
Ability to multi-task and operate effectively in both remote and in-person settings
Demonstrated problem-solver with the ability to take on complex problems and achieve a solution within a reasonable amount of time
Proven investigatory skill; ability to organize, analyze, and effectively determine risk and appropriate response; ability to remain objective and separate facts from opinions
Excellent organizational skills for prioritizing tasks to meet set deadlines
Excellent oral and written communication skills; effective interpersonal skills and customer service focus; ability to interact with individuals at all levels and personalities
- While performing the duties of this job, the employee works in normal office working conditions. Work weekends and company holidays as needed based on business regulatory requirements
- The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.
Lumeris is an EEO/AA employer M/F/V/D.
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Join Our Growing Team!
Lumeris is a value-based care managed services operator for health systems and providers seeking extraordinary clinical and financial outcomes. Lumeris aligns providers and payers across populations with technologies, processes, behaviors and information to achieve high-quality, cost-effective care with satisfied consumers — and engaged physicians.
Lumeris with Essence Healthcare, its inaugural client and learning laboratory with more than 60,000 Medicare members in Missouri and Illinois, has averaged a CMS rating of 4.5 Stars for the last ten years and produced the highest consumer and physician satisfaction scores in the industry along with significantly better clinical outcomes and lower costs. For more information, go to www.lumeris.com.
Why Join Lumeris?
At Lumeris, you will be part of team that is focused on solving the nation’s healthcare problem, and you will be able to contribute to our purpose. Our environment is fast-paced, change-oriented and focused on growth and employee engagement. At Lumeris, we know that talent is best utilized when given the opportunity to succeed. That is why we have removed the boundaries that inhibit success and focus on fostering an environment that allows employees to utilize their talents.