Complaints and Grievance Coordinator

About the role

SafeRide Health is seeking an experienced Complaints and Grievance Coordinator responsible for processing complaints and grievances, including member grievances, appeals, and provider disputes. This role ensures that cases are resolved according to client-specific requirements across all lines of business.

Responsibilities

• Maintain contractual compliance and customer satisfaction
• Ensure all assigned complaints and grievances are completed by the deadline and other contractual requirements
• Respond to Comment Letters, client inquiries, and requests
• Ensure interactions remain positive and professional with all internal and external stakeholders
• Research the details and history of a case and create a clear timeline of events
• Communicate orally and in writing with members and providers as needed
• Update members and providers regarding the progress of active and open cases
• Request, review, sort, and prepare data related to complaints and grievances
• Work with relevant departments to complete necessary follow-up and research
• Handle complaint and grievance escalations
• Provide daily, weekly, and monthly complaint and grievance updates to leadership
• Recommend solutions and collaborate with internal department leadership to correct problems and prevent recurrences
• Provide complaint and grievance data to leadership regarding provider trends
• Other duties as assigned

Requirements

• Minimum high school diploma or equivalent
• Minimum one (1) year in grievance and appeals processing
• Minimum one (1) year in an inbound call center environment

Preferred Qualifications

• Experience with Medicaid, Medicare, and NEMT guidelines
• Associate’s degree in a relevant discipline
• Knowledge of health insurance programs and benefits

Skills

• Customer-oriented with the ability to address customers’ needs while following company procedures
• Outstanding problem-solving skills and ability to use soft skills in a high-stress environment
• Strong analytical skills and the ability to use logic to solve everyday issues
• Personable, with solid leadership and mentoring skills
• Strong communication skills (verbal and written) and demonstrated ability to communicate, present, and influence effectively in person, via email, and over the phone
• Ability to meet contractual reporting requirements and deadlines
• Ability to adapt to unforeseen circumstances quickly
• Ability to respond to sensitive or complex issues with tact and sensitivity
• Proficiency in listening and problem-solving skills
• Ability to establish and maintain effective working relationships with members, coworkers, providers, and individuals of varying socio-economic, cultural backgrounds, and special needs populations
• Ability to effectively, clearly, and independently document, summarize, and resolve members’ concerns and inquiries

About Us

SafeRide Health is a technology and services company dedicated to reducing barriers to care by improving the delivery of non-emergency medical transportation to people across America. SafeRide Health leverages proprietary technology and a nationwide network of vetted transportation providers to give payers and health systems a more intelligent way to deliver cost-effective, on-demand transportation while improving the patient experience. SafeRide serves the largest Medicare Advantage, Medicaid, and provider programs in the country.