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Job Field: Government Jobs
Location: French Camp, CA
Salary: $35,102 to 50,898/year

JOB SUMMARY:

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<tr><td valign="top" width="450"><b>Under general supervision, facilitates resolution of member grievances.
Essential Functions
Receives and/or identifies grievances through a variety of sources.
Reviews grievance documentation for accuracy and conformance with standards researches using a variety of methods, and internal and external resources.
Identifies appropriate action makes or recommends adjustments.
Sends out member communications according to mandated timeframes.
Monitors and tracks grievances to ensure resolution within mandated timeframes.
Contact person during state audits related to grievances may interact with state directly on individual cases.
Represents HPSJ at administrative hearings prepares position statements.
Compiles, formats and prepares routine reports for distribution to internal and external stakeholders coordinates review and distribution.
Documents actions into appropriate systems.
Education and Experience
Required
At least two years post high school education
Three years as a Service Rep 3 or substantially similar position
Medi-Cal experience
Preferred
Associates Degree in business, social science or related
Managed care experience
Experience as a grievance coordinator or substantially similar position
Licenses, Certifications
Required
Valid California driver license and reliable transportation or, the ability to obtain transportation on demand in the counties served by HPSJ if prohibited from getting a driver license due to a medically documented disability.
Knowledge, Skills, and Abilities
Required
In-depth knowledge of the grievance process, or ability to learn within one year of hire
Strong knowledge of medical policy benefits and exclusions.
Strong knowledge of Medi-Cal programs and regulations.
Strong interpersonal skills with the ability to establish and maintain effective working relationships with diverse at all levels inside and outside of HPSJ.
Ability to use tact and diplomacy to diffuse emotional situations.
Strong oral and written communication skills, with the ability to communicate effectively and professionally, and explain complex information.
Strong listening skills.
Good organizational skills, with the ability to prioritize multiple tasks and meet deadlines.
Strong problem solving skills.
Basic analytical skills.
Ability to read, interpret and apply written guidelines, instructions and other materials
Intermediate Word and Excel skills.
Basic arithmetic skills.
Ability to work independently and as part of a team.
Ability to speak and be understood in English
Ability to treat confidential information with appropriate discretion.
Preferred
Proficient as defined by HPSJs Cultural and Linguistics Program in one of HPSJs threshold languages.
Please visit our website at www.hpsj.com
To be considered for this position, please submit application, equal employment identification form and resume
with job title to APP4HPSJ@hpsj.com or fax to 209 461 2567
Health Plan of San Joaquin is an Equal Opportunity/Affirmative Action Employer

KEY REQUIREMENTS:

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2 years Some post high school