Grievance Specialist (Temporary)

ABOUT THIS TEMP POSITION

This is a temporary position and the length of assignment is estimated to go from 10/2022 to 12/31/2022. The length of the assignment is always dependent on business need and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with.

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Grievance Supervisor, you will support the administration and resolution of medium complexity cases in support of the Alliance Grievance function.  You will assist Grievance and Quality Leadership with daily operations.  You will participate in departmental and cross departmental trainings, workgroups, and operational improvement activities.

WHAT YOU'LL NEED TO BE SUCCESSFUL

• Knowledge of:
  • The principles and practices of managed healthcare, healthcare coverage and benefit structures, principles of coordination of benefits and medical billing
  • Title 22 and Title 28 utilization management and grievance regulations 
  • The diverse needs of the Medi-Cal population
  • The principles and practices of customer service

• Ability to:
  • Identify issues, conduct research and investigations, gather and analyze information, reach logical and sound conclusions, and offer recommendations and potential consequences
  • Interpret legal, regulatory and contractual language, policies, procedures and guidelines, and legislative and regulatory directives
  • Prepare reports, correspondence and other program documents
  • Quickly learn and competently navigate computer systems, including internal tracking systems

• Education and Experience:
  • Bachelor’s degree in Health, Social Science, or a related field 
  • Minimum of three years of experience in a managed health care setting, health plan or provider office performing work related to processing provider claims, including a minimum of one year of experience administering provider disputes or member appeals and grievances (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying

OTHER DETAILS

• While this position is connected to one of our Alliance offices, we are in hybrid telecommute work environment right now and we anticipate that the interview process will take place remotely.
• Our Alliance office locations have officially re-opened as of May 2, 2022 and while some employees may work in full-time telecommute schedules, attendance at quarterly company-wide events or department meetings will be expected.
• Based on the nature of work, this position may require onsite presence, which is dependent on business need. Details about this can be reviewed during the interview process
• This is a temporary position, and does not provide the benefits that are listed below (it is standard language from our regular job posts and cannot be altered or removed)

COVID-19 Vaccine Requirement: This position requires staff to be fully vaccinated and boosted upon their start date as a condition of employment. Proof of vaccination must be submitted at time of hire. Fully vaccinated and boosted is defined as receipt of the second dose in a 2-dose series (Pfizer & Moderna vaccines) OR receipt of a single-dose vaccine (Johnson & Johnson); AND receipt of the booster (if eligible); AND a 2-week period having passed since the administration of the last vaccine dose.