Under the direction of Grievance Supervisor, the Grievance and Appeals Associate is responsible for monitoring all incoming cases, recording them in Everest, and assigning new cases to the appropriate Grievance Staff.   Provides clerical support to Grievance Staff by ensuring all correspondence is printed and mailed timely, according to DHCS timeframes and HIPAA confidentially laws.  Responsibilities also include accepting incoming calls on the ACD phone system, assisting customers.  Performs other administrative and/or clerical support to the department and/or management as needed.

• Actively monitors Everest for new incoming cases from Member Services and/or filed online directly by members. Ensures preliminary case categories are recorded accurately and assigns cases to the appropriate G&A staff, according to department guidelines.  
• Actively manages the department’s Case Assignment Tracker by recording all assigned cases
• Opens, sorts, date stamps, and distributes all department mail. Assesses new incoming mail for new Appeals or Grievances and follows protocols for entering and assigning cases in Everest.
• Prints, stuffs, and mails all correspondence supporting case investigations and/or State Hearings
• Answers incoming calls on the ACD phone with the highest level of customer service.
• Ensures that customers’ questions are addressed and/or direct calls to the appropriate person for resolution.
• Monitors all shared G&A mailboxes and handles email accordingly to department guidelines
• Review accuracy of all invoices submitted by Supervisors, obtains Director’s signature for approval, and submits approved invoices to Finance or other appropriate department for payment. Tracks and files all paid invoices.
• Creates and submits IT tickets to support onboarding of new hires. May copy and create new binders for training material
• Participates in special department projects and assignments as
• Provides administrative and/or clerical support to management and G&A staff as needed to support the department.
• Other duties as assigned. 

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated 

HIRING RANGE:

$26.25 - $30.84

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.