Experienced Grievance Customer Service Associate Analyst Team Lead – Medicare/Medicaid Grievance Resolution and Team Management

Introduction to blithequark At blithequark, we are passionate about delivering exceptional healthcare services that make a meaningful difference in the lives of our members. As a leader in the healthcare industry, we are committed to providing high-quality, patient-centered care that addresses the unique needs of our diverse membership. Our team is dedicated to fostering a culture of excellence, innovation, and collaboration, and we are seeking a talented and experienced Grievance Customer Service Associate Analyst Team Lead to join our dynamic team. About the Role The Grievance Customer Service Associate Analyst Team Lead will play a critical role in overseeing the execution and performance of our Grievance team, which is responsible for managing Medicare/Medicaid grievances presented by our members or their representatives. As a subject matter expert, you will provide guidance, instruction, direction, and leadership to the grievance team, ensuring that all grievances are resolved in a timely and compliant manner. Your expertise will be instrumental in driving key results, and your ability to collaborate with divisions within and outside the organization will be essential in resolving complex issues. Key Responsibilities Manage a team of Grievance Coordinators, with responsibility for goal and productivity management, coaching and counseling, providing feedback to the management team, and other leadership responsibilities as assigned. Deliver training to employees as needed, ensuring that new hires have the proper work tools and are trained accordingly to meet the demands of the role. Ensure that Grievance Coordinators expedite timely requests for information and that cases meet compliance requirements, adhering to CMS guidelines and regulatory timeframes. Understand blithequark's internal health plans policies and procedures, using this knowledge to frame decisions and drive results. Make critical decisions in support of the business as needed, demonstrating a deep understanding of the organization's goals and objectives. Manage all duties within CMS regulatory timeframes, interpreting CMS regulations and policies as needed to ensure compliance and adherence to industry standards. Communicate effectively with colleagues, ensuring seamless hand-offs and pick-ups of work to maintain continuity and drive results. Be responsible for ensuring that the team meets or exceeds production and quality goals, driving a culture of excellence and continuous improvement. Essential Qualifications Bachelor's or associate degree in a related field; in lieu of a degree, a high school diploma with relevant experience. 2 or more years of experience in a Medicare, Medicaid managed care environment, investigating and resolving grievances, with a deep understanding of the complexities and nuances of the industry. Experience in clinical practice, with a background in appeals and grievances, claims processing, utilization review, or utilization management/case management, demonstrating a comprehensive understanding of the healthcare landscape. Strong written and verbal communication skills, with the ability to work independently on several computer applications, including Microsoft Word and Excel, as well as corporate email. Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment, prioritizing tasks and managing multiple projects simultaneously. Preferred Qualifications Experience in a team lead or supervisory role, with a proven track record of driving results and leading high-performing teams. Advanced degree in a related field, such as healthcare administration, business administration, or a related field, demonstrating a commitment to ongoing learning and professional development. Certification in a related field, such as healthcare management or customer service, showcasing expertise and a dedication to excellence. Experience with CMS regulations and guidelines, with a deep understanding of the regulatory landscape and its implications for the organization. Skills and Competencies To be successful in this role, you will possess a unique blend of skills and competencies, including: Strong leadership and management skills, with the ability to motivate and inspire team members to achieve exceptional results. Excellent communication and interpersonal skills, with the ability to build strong relationships with colleagues, members, and stakeholders. Deep understanding of the healthcare industry, with a focus on Medicare and Medicaid managed care, and the ability to navigate complex regulatory requirements. Strong analytical and problem-solving skills, with the ability to analyze complex data and drive insights that inform business decisions. Ability to work in a fast-paced environment, prioritizing tasks and managing multiple projects simultaneously, with a focus on driving results and achieving key objectives. Career Growth Opportunities and Learning Benefits At blithequark, we are committed to the growth and development of our employees, providing opportunities for career advancement, professional development, and ongoing learning. As a Grievance Customer Service Associate Analyst Team Lead, you will have access to a range of training and development programs, including: Comprehensive onboarding program, designed to ensure a smooth transition into the role and provide a foundation for success. Ongoing training and development opportunities, focused on building skills and expertise in areas such as leadership, communication, and healthcare management. Coaching and mentoring programs, designed to support career growth and development, and provide guidance and support from experienced leaders. Opportunities for career advancement, with a focus on promoting from within and developing future leaders. Work Environment and Company Culture At blithequark, we are proud of our dynamic and inclusive work environment, which is built on a foundation of respect, empathy, and compassion. Our company culture is characterized by: A commitment to excellence, with a focus on driving results and achieving key objectives. A culture of collaboration, with a emphasis on teamwork, communication, and mutual support. A dedication to diversity, equity, and inclusion, with a focus on creating a workplace that is welcoming and inclusive to all employees. A focus on employee well-being, with a range of programs and initiatives designed to support physical, emotional, and mental health. Compensation, Perks, and Benefits As a Grievance Customer Service Associate Analyst Team Lead at blithequark, you will be eligible for a range of compensation, perks, and benefits, including: Competitive hourly rate, with a range of $17 - $26 per hour, depending on experience and location. Annual bonus plan, with opportunities to earn additional compensation based on performance and contributions to the organization. Comprehensive range of benefits, including medical, vision, dental, and well-being and behavioral health programs. 401(k) with company match, providing a foundation for long-term financial security and retirement planning. Company-paid life insurance, providing peace of mind and financial protection for employees and their families. Tuition reimbursement, supporting ongoing learning and professional development. Minimum of 18 days of paid time off per year, plus paid holidays, providing opportunities for rest, relaxation, and rejuvenation. Conclusion If you are a motivated and experienced healthcare professional, with a passion for delivering exceptional customer service and driving results, we encourage you to apply for the Grievance Customer Service Associate Analyst Team Lead role at blithequark. As a member of our team, you will have the opportunity to make a meaningful difference in the lives of our members, while advancing your career and developing your skills and expertise. Join us in our mission to deliver exceptional healthcare services and make a positive impact on the lives of those we serve. Apply for this job