Customer Service Grievance Specialist

About the role

The Customer Service Grievance Specialist is responsible for assuring that DWIHN’s grievance process is carried out in accordance with local, state, and federal regulations, BBA, Mental Health Code mandates and MDHHS contract. This position is under the general supervision of the Director of Customer Service.

Responsibilities

• Assists with the development of grievance process and procedures in accordance with Federal Rules, MDHHS guidelines, Michigan Mental Health Code and DWIHN policies and procedures.
• Provides applicable Customer Service information, referral, and linkage.
• Provides oversight of telephone and walk-in-inquiries.
• Assists with the monitoring of the grievance process at DWIHN and contractor network to ensure compliance with established policies and procedures.
• Collaborates and coordinates with various internal/external entities to ensure that issues are addressed in accordance with mandated policies and procedures.
• Maintains the reporting mechanism that tracks and monitors DWIHN and contractor’s network complaints and grievances.
• Assists in the review and analysis of grievance data for reporting of trends and patterns.
• Assists in the preparation of weekly, monthly, quarterly, and annual DWIHN, ICO and MDHHS reports on grievance activity.
• Provides technical assistance to DWIHN staff and contractors on grievance protocol and applicable dispute resolution protocols.
• Develops and implements on-going grievance training modules specific to applicable audiences.
• Assists in the development and maintenance of standardized grievance educational and informational materials.
• Attends periodic meetings within DWIHN and/or the community to address DWIHN’s issues and updates that are applicable to grievance activities.
• Fosters a climate of collaboration and innovation to improve upon community integration and wellness outcomes among individuals who receive services.

Qualifications

A Bachelor’s Degree in Social Work, Psychology, Healthcare Administration, Health Management, Business Administration, Conflict Resolution or a related field is required. Four (4) years of full-time paid experience in complex cross-functional dispute resolutions or enrollee/member relations, or four (4) years of full-time paid experience in a member facing Customer Service position is also required. A valid State of Michigan Driver’s License with a safe and acceptable driving record is necessary.

Skills

• Knowledge of DWIHN policies, procedures, and practices.
• Knowledge of the DWIHN provider network and community resources.
• Knowledge of the Michigan Mental Health Code.
• Knowledge of MDHHS policies, rules, regulations, and procedures.
• Knowledge of the appeals and grievance processes for behavioral health systems.
• Knowledge of dispute resolution practices and procedures.
• Knowledge of customer service.
• Knowledge of compliance standards.
• Knowledge of the Federal Confidentiality Regulations, 42 CFR, Part 2.
• Assessment skills.
• Organizational skills.
• Analytical skills.
• Time Management skills.
• Report writing skills.
• Decision Making skills.
• Customer Service skills.
• Communication skills.
• Active Listening skills.
• Multitasking skills.
• Prioritizing skills.
• Written communication skills.
• Accuracy and detailed oriented skills.
• Investigation skills.
• Training skills.
• Computer skills (Word, Excel, Access, Power Point, Outlook, Teams).

Working Conditions

Work is usually performed in an office setting but requires the employee to drive to different sites throughout Wayne County and the State of Michigan. This position can work remotely with supervisory approval. Currently, this position is primarily a remote position.