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 a high level of productivity to achieve the department's overall performance metrics and to meet and/or exceed member satisfaction. Responsibilities include the oversight of Appeals and Grievance Specialists, monitoring work, providing feedback, training, coaching, mentoring, and ensuring compliance with policies, procedures, and regulations.Duties
Lead day-to-day activities of the Appeals and Grievances team.Provide direction to the team and handle internal or external questions related to Appeals or Grievances.Assist Supervisors to ensure accurate, timely, and quality responses.Ensure compliance with departmental policies and standards.Provide statistical reports to aid in evaluating Compliance status.Train and motivate staff, ensuring compliance standards are maintained.Manage daily office workflow and recommend enhancements to processes and procedures.Act as a back-up to the Supervisor, leading meetings and handling escalations as required.Manage complex projects, updating key stakeholders and ensuring timely deliverables.Perform other duties as assigned.Education Required
Associate's Degree. In lieu of degree, equivalent education and/or experience may be considered.Education Preferred
Bachelor's Degree.Experience
Required:At least 4 years of Appeals and Grievance experience.At least 1 year of leading process, program, or staff experience.Preferred:Experience working with disadvantaged populations, Medi-Cal, Covered California, and Cal MediConnect.One year lead experience in a health plan/healthcare.Skills
Required:Strong knowledge of CMS, DMHC, and DHCS regulations.Knowledge of Medical Terminology.Excellent written and verbal communication skills.Strong analytical, coaching/mentoring, and team-building skills.Ability to work effectively with diverse team members.Ability to troubleshoot problems and provide optimal customer service.Flexibility to work weekends and manage multiple tasks.Advanced PC skills including Word, Excel, and Access.Organized, detail-oriented, and able to exercise strong independent judgment.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.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 a high level of productivity to achieve the department's overall performance metrics and to meet and/or exceed member satisfaction. Responsibilities include the oversight of Appeals and Grievance Specialists, monitoring work, providing feedback, training, coaching, mentoring, and ensuring compliance with policies, procedures, and regulations.Duties
Lead day-to-day activities of the Appeals and Grievances team.Provide direction to the team and handle internal or external questions related to Appeals or Grievances.Assist Supervisors to ensure accurate, timely, and quality responses.Ensure compliance with departmental policies and standards.Provide statistical reports to aid in evaluating Compliance status.Train and motivate staff, ensuring compliance standards are maintained.Manage daily office workflow and recommend enhancements to processes and procedures.Act as a back-up to the Supervisor, leading meetings and handling escalations as required.Manage complex projects, updating key stakeholders and ensuring timely deliverables.Perform other duties as assigned.Education Required
Associate's Degree. In lieu of degree, equivalent education and/or experience may be considered.Education Preferred
Bachelor's Degree.Experience
Required:At least 4 years of Appeals and Grievance experience.At least 1 year of leading process, program, or staff experience.Preferred:Experience working with disadvantaged populations, Medi-Cal, Covered California, and Cal MediConnect.One year lead experience in a health plan/healthcare.Skills
Required:Strong knowledge of CMS, DMHC, and DHCS regulations.Knowledge of Medical Terminology.Excellent written and verbal communication skills.Strong analytical, coaching/mentoring, and team-building skills.Ability to work effectively with diverse team members.Ability to troubleshoot problems and provide optimal customer service.Flexibility to work weekends and manage multiple tasks.Advanced PC skills including Word, Excel, and Access.Organized, detail-oriented, and able to exercise strong independent judgment.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.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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