ATHENA CONSULTING JOB LISTINGS
Grievance and Complaint Coordinator
We are currently hiring for the
Maryland Behavioral Health Administrative Services Project!
ATHENA Consulting is an award-winning staffing firm serving state and local governments. Our mission is to make lives better! We make our Clients’ Lives Easier by engaging and supporting our clients and partnering with them to be the most knowledgeable staffing partner. We make our Employees’ Lives Better by identifying and cultivating their talents and matching these talents with our customers’ needs. ATHENA places a high value on customer service, accountability and getting the job done.
POSITION SUMMARY:
This FULL-TIME position ranges from $17.00-$19.00 per hour depending on experience and is located in Hanover, Maryland. The Grievance and Complaint Coordinator is responsible for reviewing, analyzing, and processing claims in accordance with company policies and claims events to determine the extent of the company's liability and entitlement, and related duties as assigned.
This position is a hybrid role and is required to go into a Carelon Pulse Point Center 1 day a week.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:
- Conducts investigations and reviews customer grievances and appeals involving the provision of service and benefit coverage issues.
- Contacts customers to gather information and communicates the disposition of cases; documents interactions.
- Generates written correspondence to customers, such as members, providers, and regulatory agencies.
- Performs research to respond to inquiries and interprets policy provisions to determine the extent of the company's liability and/or providers' or beneficiaries' entitlements.
- Responds to appeals from Customer Service Units, Provider Inquiry Units, members, providers, and/or others for resolution or affirmation of previously processed claims.
- Ensures appropriate resolution to inquiries, grievances, and appeals within specified timeframes established by either regulatory/accreditation agencies or customer needs.
- Identifies barriers to customer satisfaction and recommends actions to address operational challenges.
Required Skills/Abilities:
- Strong crisis intervention and assessment skills.
- Excellent verbal, written, and listening communication skills within the English language.
- Proven, high quality customer service (internal and external customers).
- Ability to work collaboratively.
- Solid ability to analyze situations carefully and adopt appropriate courses of action.
- Ability to understand and adhere to the duties, methods, and procedures required by the position.
- Excellent organizational skills and attention to detail.
- Ability to prioritize tasks.
- Ability to effectively communicate to large and small group audiences.
- Proficient with Microsoft Office Suite or related software.
Education and Experience:
- High school diploma or equivalent required.
- Minimum of 1 year experience in the health insurance business, including customer service experience, or any combination of education and experience which would provide an equivalent background.
- A writing sample will be required if chosen for an interview.
Physical Requirements:
- Possible prolonged periods of sitting at a desk and working on a computer.
- Must be able to lift and move up to 25 pounds at times.
- Standard hours of work Monday through Friday, 8:00 am – 5:00 pm.
- Travel may be required up to 25% of the time.
Successful ATHENA employees will display the following characteristics:
- You strive to be the best in your field currently and in the future.
- You like to make your employer look good.
- You find solutions, where others only see problems.
- You are proactive, you make and meet commitments, and you perform your duties exceedingly well.
- You are aware of the employer’s needs at all times and are well-versed in what you personally and ATHENA can offer them as a whole.
- You have the ability to work with diverse, integrated, deliverable-driven teams to accomplish the larger mission.
The benefits of working for ATHENA include a full Benefit package:
- Support from a team of professionals committed to making your life better.
- 19 days of PTO.
- 12 paid holidays, 13 paid holidays during election years.
- Merit / COLA increases.
- Flex time allowed, during the same week.
- Medical, dental and vision insurance.
- Medical and dependent flexible spending account.
- Pet insurance.
- Mass transportation benefit for the Maryland and Washington, D.C. area.
- 401k with a generous employer match.
- Easy to use employee self-serve HR portal.
The statements in this Job Posting are intended to describe the general nature and minimum level of work required. The content should not be construed as a complete list of all duties, responsibilities, and skills required to meet the criteria for this position. Upon request, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Application for employment is not intended to and does not create a contract or offer of employment and if hired, employment with the company is on an at-will basis and could be terminated at the will of either party.
ATHENA Consulting LLC does not discriminate in hiring based on federally protected classifications to include but not limited to race, color, religion, national or ethnic origin, sex, sexual orientation, gender identity or expression, age, disability, protected veteran status, marital status or other characteristics protected by law. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.
