Experienced Grievance Customer Service Team Lead – Medicare/Medicaid Grievance Resolution and Compliance

Are you a seasoned professional with a passion for delivering exceptional customer service and driving results in a fast-paced environment? Do you have a strong background in Medicare and Medicaid managed care, with experience in investigating and resolving grievances? If so, we invite you to join our team as an Experienced Grievance Customer Service Team Lead at arenaflex, a leading healthcare company dedicated to improving lives through better health.

About arenaflex

arenaflex is a dynamic and innovative healthcare company that advocates for better health through every stage of life. We guide our customers through the healthcare system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Our team is passionate about driving growth and improving lives, and we're committed to creating a positive impact in the communities we serve.

Job Summary

As an Experienced Grievance Customer Service Team Lead, you will be responsible for overseeing the execution and performance of our Grievance team, providing guidance, instruction, direction, and leadership to our Grievance Coordinators. You will work collaboratively with divisions within and outside the organization to resolve issues in a timely and compliant manner, ensuring that our customers receive exceptional service and support. Your expertise in Medicare and Medicaid managed care, as well as your experience in investigating and resolving grievances, will be invaluable in driving success in this role.

Responsibilities

* Manage a team of Grievance Coordinators, providing guidance, instruction, direction, and leadership to achieve key results

• Monitor the quantitative and qualitative achievements of the team and report results to management
• Enable Grievance Coordinators to bring cases to resolution within CMS guidelines
• Deliver training to employees as needed and ensure new hires have proper work tools and are trained accordingly
• Ensure Grievance Coordinators expedite timely requests for information and that cases meet compliance
• Understand Cigna's internal health plans policies and procedures to frame decisions
• Make critical decisions in support of the business as needed
• Manage all duties within CMS regulatory timeframes and Interpret CMS regulations and policies as needed
• Communicate effectively to hand-off and pick-up work from colleagues
• Responsible for ensuring that the team meets/exceeds production and quality goals

Qualifications

* Bachelor's or associate degree in a related field (or equivalent experience)

• 2+ years of experience in a Medicare, Medicaid managed care environment investigating and resolving grievances
• Experience in clinical practice with experience in appeals & grievances, claims processing, utilization review or utilization management/case management
• Strong written and verbal communication skills
• 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
• High-speed internet connection (at least 10Mbps download/5Mbps upload) for remote work

Skills and Competencies

* Strong leadership and management skills, with the ability to motivate and guide a team to achieve results

• Excellent communication and interpersonal skills, with the ability to work effectively with colleagues, customers, and stakeholders
• Strong analytical and problem-solving skills, with the ability to interpret CMS regulations and policies
• Ability to work in a fast-paced environment, with multiple priorities and deadlines
• Strong attention to detail and organizational skills, with the ability to manage multiple tasks and projects simultaneously
• Ability to adapt to changing priorities and requirements, with a flexible and positive attitude

Career Growth Opportunities and Learning Benefits

* arenaflex is committed to the growth and development of our employees, with opportunities for career advancement and professional development

• We offer a comprehensive training program, with ongoing support and guidance to help you succeed in your role
• Our team is passionate about learning and growth, with a culture that encourages collaboration, innovation, and continuous improvement

Work Environment and Company Culture

* arenaflex is a remote-friendly company, with a flexible work environment that allows you to work from home or in our office

• Our team is passionate about creating a positive and inclusive work environment, with a culture that values diversity, equity, and inclusion
• We offer a comprehensive range of benefits, including medical, vision, dental, and well-being and behavioral health programs, as well as 401(k) with company match, company paid life insurance, tuition reimbursement, and paid time off

Compensation and Benefits

* Competitive hourly rate of $17-$26 per hour, depending on experience and geographic location

• Eligible to participate in an annual bonus plan
• Comprehensive range of benefits, including medical, vision, dental, and well-being and behavioral health programs
• 401(k) with company match
• Company paid life insurance
• Tuition reimbursement
• Paid time off and paid holidays

How to Apply

If you're a motivated and experienced professional with a passion for delivering exceptional customer service and driving results in a fast-paced environment, we invite you to apply for this exciting opportunity. Please submit your application, including your resume and a cover letter, to [insert contact information]. We look forward to hearing from you!

Equal Employment Opportunity

arenaflex is an equal opportunity employer, committed to creating a diverse and inclusive work environment. We welcome applications from qualified candidates of all backgrounds, and we are committed to providing reasonable accommodations to applicants with disabilities. If you require reasonable accommodation in completing the online application process, please email [insert contact email] for support. Apply for this job