Grievance Specialist

The Grievance Specialist at Healthfirst manages and resolves member grievances and complaints across various health plans, ensuring compliance and advocacy for members in a non-clinical role.

Location: Greater New York City Area (NY, NJ, CT residents)

Salary: $58,900 - $80,070

Responsibilities

• Manage a caseload of grievances from acknowledgment to resolution.
• Conduct detailed research and collaborate with internal departments.
• Partner with external vendors to address member issues.
• Draft and issue regulatory-compliant resolution letters.
• Ensure accurate case documentation.
• Participate in meetings, audits, training, and performance reviews.
• Meet department metrics for production and quality.

Requirements

• HS Diploma or GED.
• Understanding of utilization management processes.
• Proficient in Microsoft Office Suite and case tracking systems.

Benefits

• Medical, dental, and vision coverage.
• Incentive and recognition programs.
• Life insurance.
• 401k contributions.

Additional Information

• Position is non-clinical, focused on grievance resolution.
• Requires understanding of healthcare regulations and managed care.