Jobs in America

Specialist, Complaints and Grievances

Mission
FULL TIME
High School 1 Year

The position of Specialist, Complaints and Grievances has become available since January 3, 2024 and will be closed on March 20, 2024. The employer not disclosing the salary means that you have the chance to negotiate it. Have you thought about whether full time work is a good fit for you? This job is in Mission, but it's a remote job that you can do from anywhere. It is necessary to have passed High School to be considered for this job. This job also requires that you have a minimum of 12 months of experience in the same field.

Who We Are

At Lucet, we are industry leaders in behavioral health, dedicated to helping people live healthy, balanced lives. Our mission - and our passion - is to improve the lives of the members we serve and be the ideal partner for our providers.

Lucet's unique combination of people and technology has proven to optimize access to behavioral health care providers and increase a health plan's ability to connect members to quality care. With the industry's largest network of care navigators and technology powered by more than six million assessments and more than 20 years of data, Lucet is the only solution proven to successfully identify and connect people across the entire acuity spectrum with the right care in less than five days on average, and often as little as one day.

Our members, providers and partners fully entrust us to deliver outstanding quality care through coordinated behavioral health services, employee assistance programs, organizational consulting, student well-being programs and more.

When you join Lucet, you become a valued member of our team, serving more than 15 million people across the U.S. Our employees have a passion for helping others - and it shows. From entry-level employees to senior leaders, we are inspired by our members, putting them first in everything we do. From day one, you'll see firsthand the impact you have on our members, knowing you can make a true difference in their lives.


Job Summary

The Complaints and Grievances Specialist (CS) is accountable for processing complaints and grievances according to accreditation, regulatory and contractual requirements. The CS must understand member and provider rights and responsibilities, how to submit a complaint, the timeframes for acknowledging, responding to, and resolving a complaint. The Complaints and Grievances Specialist documents all aspects of complaints including receipt date and time, full investigation of the substance of the complaint and any records, written comments or information pertaining to the complaint. The CS is responsible for triaging all new complaints and incident submissions to team members. The CS also assists with reporting, audits, and managing multiple external email and fax boxes for new inquiries.

Essential Functions

  • Appropriately process and document complaints and grievances, all investigative steps, and resolution in complaints system
  • Investigate and resolve non-clinical complaints and grievances in accordance with standard policies and procedures
  • Monitor time standards and assist internal department leads with adherence to timeframes
  • Communicate detailed account of risk management issues to quality leadership in a timely manner
  • Ensure compliance with HIPAA regulations, to include confidentiality and appropriate authorization on file, e.g. appointed representative, signed release of information, etc.
  • Support quality leadership with timely response to external inquiries (customer, DOI, other) and by assisting with extracting reports from the complaint system for both internal and external customers
  • Triage all incoming complaints and incidents in a timely manner per internal polices and procedures
  • Monitor new complaints for trending purposes and notify leadership if new trend is discovered
  • Support the department by managing multiple external email and fax boxes for incoming inquires
  • Responsible for navigating different health plan's systems and meeting all requirements for maintaining access to the systems
  • Communicate professionally with members, customers, providers, and other stakeholders regarding complaints or grievances
  • Escalate any potential quality of care concerns or critical incidents to Quality leadership
  • Assist with internal and external audits, as needed
  • Actively participate in and positively contribute to team processes and lead team activities
  • Adheres to Lucet Mission Statement, Core Values, Code of Business Conduct, and Compliance Program.
  • Complies with all Federal and applicable State laws and Lucet Policies regarding, privacy, confidentiality, and security of health information, and other designated information.


Job Qualifications

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Required

  • High School Diploma and 3 or more years of experience in a healthcare or administrative environment.
  • Professional demeanor and ability to work collaboratively with multiple levels of professionals, management, and line staff
  • Advanced knowledge in Microsoft Office (Word, Excel, Outlook. Etc.)
  • Strong written and oral communication skills
  • Accuracy, timeliness and compliance with all aspects of complaints and grievance processes.

Preferred

  • Associate's degree in health care, business, or related field and with 2 or more years of experience in a healthcare or administrative environment.
  • Experience in managed care industry
  • Experience with complaints and grievances in a healthcare setting, minimum 1 year
  • Medicare or Medicaid experience
  • Experience applying accreditation and regulatory requirements and ensuring ongoing compliance

Key Competencies

  • Ability to work and make decisions independently
  • Empathy
  • Critical thinking
  • Flexibility
  • Ability to multi-task
  • Highly organized and detail-oriented
  • Adaptable to various software programs
  • Problem Solving

Working Conditions

  • Work is performed indoors in a home-office environment - not substantially exposed to adverse environmental conditions.
  • Frequent exposure to VDT screens, video calling, and computers.
  • Physical demands include constant ability to remain in a stationary position, move about inside an office or remote setting, able to communicate and exchange information with others, able to inspect information, and able to perform repetitive motion with arms and fingers.
  • Mental demands include constant ability to interpret data, problem solve, make decisions, and organize and plan.

Salary and Other Compensation:

The starting rate that Lucet reasonably expects to pay for this position ranges from $20.00 - $31.00 per hour, depending on circumstances including an applicant's skills, education/degrees, certifications, prior experience, market data, and other relevant factors.

This position is eligible for a bonus in accordance with the terms of Lucet's incentive plan based on both company performance and individual performance.

Benefits: The Company offers the following benefits for this position, subject to applicable eligibility requirements: Medical, Dental, Vision, 401(k) with competitive employer match, company paid life and disability insurance, company paid gym access, tuition reimbursement, parental leave, PTO (vacation, sick and volunteering), Remote Work.

If you're not sure if the job is a good fit for you, review the job posting again to clarify any questions. Recruiters are looking for candidates who take the time to submit well-crafted, error-free job applications. We welcome applications from individuals who are passionate about this job opportunity and can fulfill the requirements. Please make sure to read the job posting carefully before submitting an application.