Organization: Partnership HealthPlan of California
Location: Fairfield, CA
Date Job Posted: January 9, 2020
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Supervisor of Grievance & Appeals
Job Locations US-CA-Fairfield
Job ID 2019-1706 FLSA Status Exempt
Under direction of the Manager or above, provides supervision of the assigned Grievance staff, and assists in the day-to-day operations in the Grievance Unit by providing leadership, direction, and support to Lead Grievance Coordinators, Grievance Coordinators, and Grievance Resolution Specialists.
Education and Experience
Bachelor’s degree in related field and minimum three (3) years’ experience in managed care health insurance environment. Ability to interview and investigate emotional situations with a level of sensitivity and understanding. Ability to listen effectively and appropriately respond to difficult and/or urgent situations. Demonstrate good analytical skills and the ability to problem solve creatively, objectively, and rapidly. Excellent interpersonal/verbal communication skills. Demonstrated conflict resolution and mediation skills.
Special Skills, Licenses and Certifications
Thorough working knowledge of managed care concepts, policies, and procedures. Ability to understand, interpret, and prepare documentation used in legal cases. Working knowledge of business software applications. Proficient use of computer keyboard to access data. Bilingual skills in Spanish, Tagalog, or Russian may be required. Valid California driver’s license and proof of current automobile insurance compliant with PHC policy are required to operate a vehicle and travel for company business.
Performance Based Competencies
Ability to learn quickly and acquire in-depth knowledge of software used at PHC. Excellent analytical skills to troubleshoot and resolve system problems. Able to develop procedures and document extensively and clearly. Excellent oral and written communication skills. Excellent analytical and interpersonal skills. Ability to assess and resolve customer complaints, problems, and issues in an effective manner. Excellent organizational skills. Ability to prioritize issues, use good judgment skills, and handle sensitive issues with confidentiality, tact, and diplomacy.
Work Environment And Physical Demands
Ability to use computer keyboard. More than 60% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects, weighing up to 25 lbs
All HealthPlan employees are expected to:
IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.