Complaints & Grievances Specialist

About the role

CBH is a dynamic organization dedicated to providing access to high-quality, accountable care to improve the health and mental wellness of our members. The Complaints & Grievances Specialist is responsible for completing thorough investigations of members’ complaints and processing grievances, conducting and participating in hearings, and ensuring all State mandates are followed.

Responsibilities

• Review, document, and process all levels of complaints and grievances
• Complete packets for and participate in Fair Hearings
• Review and address quality concerns stemming from complaints and grievances to determine level of follow-up required (e.g., investigating or tracking)
• Travel is required for this position

Requirements

• Master’s degree in behavioral health, healthcare, or social sciences
• Minimum of 2 years of experience in a managed care or quality management setting

Skills

• Proficient in Microsoft Office applications
• Excellent written and verbal communication skills
• Knowledge of PA Act 146, Appendix H, and medical necessity criteria
• Excellent customer service skills
• Excellent training and facilitating skills
• Strong interpersonal skills
• Thorough knowledge of DBH and DHS systems and services

Work conditions

• Regularly requires walking, standing, stooping, bending, sitting, reaching, pushing, pulling, and/or repetitive wrist/hand movements for various lengths of time throughout the day
• Ability to utilize computers and office equipment to complete daily work responsibilities
• Regularly works indoors in adequately lighted and ventilated areas with some temperature fluctuation; no protective equipment routinely needed
• Must be able to adapt to continuous changes and demands of the job
• Must be able to travel

Benefits

• Family planning, fertility, and adoption benefits
• 403(b) retirement plan
• PTO days and sick days
• Wellness program
• Employee assistance program
• Health, dental, and vision insurance
• Medical and prescription drug insurance
• Tuition reimbursement
• Commuter benefits
• Flexible spending accounts

Pay

Annual salary: $58,300

Additional requirements

The successful candidate must be a current Philadelphia resident or become a resident within six months of hire.