L.A. Care Health Plan
Lead Customer Solution Center Appeals and Grievances
L.A. Care Health Plan, Los Angeles, California, United States, 90079
Lead Customer Solution Center Appeals and Grievances
Job Category:
Customer ServiceLocation:
Los Angeles, CA, US, 90017Position Type:
Full TimeRequisition ID:
11614Salary Range:
$67,186.00 (Min.) - $87,342.00 (Mid.) - $107,498.00 (Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan, serving more than 2 million members.Mission:
L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents.The Lead of Customer Solution Center Appeals and Grievances is responsible for assisting with the development of a successful and cohesive Appeals and Grievance unit, ensuring high levels of productivity to achieve the department's performance metrics and meet/exceed member satisfaction. Responsibilities include oversight of Appeals and Grievance Specialists, monitoring work, providing performance feedback, training, coaching, mentoring, and ensuring compliance with policies and regulations.Duties
Lead day-to-day activities of the Appeals and Grievances team, including providing direction, handling internal/external questions, and implementing resolutions and process improvements.Assist Supervisor to ensure Specialists provide accurate, timely, and quality responses.Ensure departmental policies and standards are followed to meet organizational goals.Identify deviations in performance and adjust processes accordingly.Provide accurate and timely statistical reports to aid in evaluating compliance status.Support and lead the distribution of inventory/assignments as needed.Train and motivate staff while ensuring compliance standards are maintained.Collaborate with management to review performance and quality standards.Act as a back-up to the Supervisor, leading meetings and handling escalations.Manage complex projects, engaging stakeholders and developing timelines.Perform other duties as assigned.Education Required
Associate's Degree (or equivalent education/experience may be considered).Education Preferred
Bachelor's DegreeExperience
Required:
At least 4 years of Appeals and Grievance experience, with experience interpreting and applying regulations. At least 1 year of leading processes, programs, or staff.Preferred:
Experience with disadvantaged populations, Medi-Cal, Covered California, and Cal MediConnect. One year of lead experience in a health plan/healthcare.Skills
Required:Strong knowledge of CMS, DMHC, and DHCS regulations.Medical Terminology knowledge.Excellent written and verbal communication skills.Strong analytical, coaching/mentoring, and team-building skills.Ability to work effectively with diverse team members.Problem-solving skills to handle irate members and provide optimal customer service.Flexibility to work weekends.Multitasking ability to streamline operations.Advanced PC skills including Word, Excel, and Access.Organized, detail-oriented, and able to exercise strong independent judgment.Licenses/Certifications Required
Licenses/Certifications Preferred
Required Training
Physical Requirements
LightAdditional Information
This position requires work after hours, on weekends, holidays, a hybrid remote schedule, and flexibility in hours/shift in critical situations.This position requires handling various caseloads and flexibility to adapt to changing priorities.Salary Range Disclaimer:
The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.L.A. Care offers a wide range of benefits including
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Job Category:
Customer ServiceLocation:
Los Angeles, CA, US, 90017Position Type:
Full TimeRequisition ID:
11614Salary Range:
$67,186.00 (Min.) - $87,342.00 (Mid.) - $107,498.00 (Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan, serving more than 2 million members.Mission:
L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents.The Lead of Customer Solution Center Appeals and Grievances is responsible for assisting with the development of a successful and cohesive Appeals and Grievance unit, ensuring high levels of productivity to achieve the department's performance metrics and meet/exceed member satisfaction. Responsibilities include oversight of Appeals and Grievance Specialists, monitoring work, providing performance feedback, training, coaching, mentoring, and ensuring compliance with policies and regulations.Duties
Lead day-to-day activities of the Appeals and Grievances team, including providing direction, handling internal/external questions, and implementing resolutions and process improvements.Assist Supervisor to ensure Specialists provide accurate, timely, and quality responses.Ensure departmental policies and standards are followed to meet organizational goals.Identify deviations in performance and adjust processes accordingly.Provide accurate and timely statistical reports to aid in evaluating compliance status.Support and lead the distribution of inventory/assignments as needed.Train and motivate staff while ensuring compliance standards are maintained.Collaborate with management to review performance and quality standards.Act as a back-up to the Supervisor, leading meetings and handling escalations.Manage complex projects, engaging stakeholders and developing timelines.Perform other duties as assigned.Education Required
Associate's Degree (or equivalent education/experience may be considered).Education Preferred
Bachelor's DegreeExperience
Required:
At least 4 years of Appeals and Grievance experience, with experience interpreting and applying regulations. At least 1 year of leading processes, programs, or staff.Preferred:
Experience with disadvantaged populations, Medi-Cal, Covered California, and Cal MediConnect. One year of lead experience in a health plan/healthcare.Skills
Required:Strong knowledge of CMS, DMHC, and DHCS regulations.Medical Terminology knowledge.Excellent written and verbal communication skills.Strong analytical, coaching/mentoring, and team-building skills.Ability to work effectively with diverse team members.Problem-solving skills to handle irate members and provide optimal customer service.Flexibility to work weekends.Multitasking ability to streamline operations.Advanced PC skills including Word, Excel, and Access.Organized, detail-oriented, and able to exercise strong independent judgment.Licenses/Certifications Required
Licenses/Certifications Preferred
Required Training
Physical Requirements
LightAdditional Information
This position requires work after hours, on weekends, holidays, a hybrid remote schedule, and flexibility in hours/shift in critical situations.This position requires handling various caseloads and flexibility to adapt to changing priorities.Salary Range Disclaimer:
The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.L.A. Care offers a wide range of benefits including
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