Grievance & Appeals Case Analyst
Partnership HealthPlan of CaliforniaFairfield, California, United States • Redding, California, United States • Eureka, California, United States • Chico, California, United States
Posted October 28, 2023
72364.92 - 90456.15 USD year
Full Time
About the Company
Partnership HealthPlan of California is a non-profit community-based health care organization that administers Medi-Cal benefits through local providers, ensuring high-quality, cost-effective health care for recipients. With a mission to help members and communities be healthy, the organization aims to be the most respected managed care plan in California.
Job Description
This position is for a Grievance & Appeals Case Analyst to review, investigate, and resolve member grievances and appeals. The role involves transforming member dissatisfaction into member satisfaction, ensuring compliance with DHCS guidelines and NCQA standards, and maintaining customer service. The analyst will work independently and within leadership, prioritizing case deliverables.
Requirements
- Independently determine best resolution on assigned cases
- Investigate member-disputes, collect new evidence, and reassess coverage
- Meet DHCS, NCQA standards, and Partnership best practices
- Maintain casework activities meticulously
- Document all casework activity accurately and ethically
