Job Description
Job Title: Grievance Support Clerk
Pay Rate: $19/hour
Job Summary:
Under general supervision, the Grievance Support Clerk works directly with members to support the grievance process. This position involves frequent communication with members, internal departments, providers, and the grievance team to ensure timely and accurate resolution of member grievances in alignment with established procedures and regulatory guidelines.
Key Qualifications:
Self-motivated with strong critical thinking skills
Excellent attendance and reliability
Proficient in Microsoft Excel, Word, and Adobe
Primary Responsibilities:
Collaborate with members, providers, and Grievance Coordinator II to resolve grievances
Act as a member advocate in every interaction
Log, research, and respond to grievances within required timeframes
Present cases to clinical grievance team or Medical Director and review outcomes with management
Maintain accurate grievance logs for analysis and reporting
Organize and maintain grievance files in compliance with policies and regulatory standards
Participate in audits by regulatory agencies as needed
Ensure every grievance received via any channel is properly documented and acknowledged
Coordinate grievance resolution in compliance with DMHC and DHCS requirements
Assist members in submitting grievances and follow up on critical issues
Collaborate with other departments to facilitate resolution
Promote positive member and provider relations
Identify and report systemic issues to management for corrective action
Document member feedback and interactions in the system (QNXT)
Support member retention through professional and timely grievance resolution
Contribute data to monthly and quarterly grievance reports
Comply with all internal policies and procedures
Commitment to Diversity: As an equal opportunity employer committed to meeting the needs of a multi-generational and multicultural workforce, Key Staffing recognizes that a diverse staff, reflective of our community, is an integral and welcome part of a successful and ethical business. We hire local talent at all levels regardless of race, color, religion, age, national origin, gender, gender identity, sexual orientation, or disability and actively foster inclusion in all forms both within our company and across interactions with clients, candidates, and partners.
If this position caught your eye, send us your resume! For best consideration, include the job title and source where you found this position in the subject line of your email to knegrete@hirekeystaff.com.
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