Responsibilities:

Working with the Operations Supervisor or Grievance Coordinator, the Grievance Associate is responsible for ensuring all problems, complaints and grievances, presented by Plan members or their representatives are resolved in accordance with established policies and procedures as well as, NCQA and Federal/State guidelines. Under the supervision of the Operations Supervisor or Grievance Coordinator, the Grievance Associate acts as a member advocate and communicates with medical facility administrators, providers, physicians and all applicable AMFC departments to interpret and enhance understanding of the Plan's policies and procedures relative to complaints and grievances. The Grievance Associate is responsible for accurately documenting, in the appropriate computer system, all correspondence associated with the grievance. The Grievance Associate will thoroughly research questions and issues in order to provide an accurate explanation. The Grievance associate tracks and reports turnaround time and keeps abreast of all cases to ensure that the 30-day time limit for case resolution is met for 100% of all grievances. The associate will provide Complaint/Grievance training for the Plan's staff in the base unit and all supporting departments. The Grievance Associate will perform other related duties and projects as assigned.

Education/ Experience:

• 1 to 3 years previous experience in direct contact with members in relation to any complaints and/or grievances.
• High School/GED required.
• Associate's Degree (preferred).
• Basic computer skills including Microsoft Word, Excel and PowerPoint.