Grievance Manager

 

Job Summary:

Grievance Manager

Enhance Health is a rapidly growing Medicare organization poised for explosive growth through the creation of meaningful insurance sales conversations. As a startup- your talents and vision can make a real impact on the company's future. You'll make tangible contributions to the success of our organization, which is already backed by one of the world's biggest private equity firms, and a team who's eager for your unique and valuable perspective.

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About The Position

The Grievance Manager is responsible for overseeing the handling and resolution of grievances and

complaints pertaining to Enhance Health’s ongoing health insurance product marketing, sales, and
services business. Such complaints and grievances may originate directly from consumers, health
insurance companies, or regulatory agencies. This position will ensure compliance with applicable state
and federal regulations while providing a high level of customer satisfaction. The Grievance Manager will
report directly to the Director of Compliance and work closely with other departments to address and resolve customer complaints..


Key Responsibilities:

• Manage and oversee the company's grievance and complaints processes, ensuring timely and accurate resolution of complaints and grievances in accordance with state and federal regulations, as well as company policies and procedures.
• Assist health insurance companies with whom Enhance Health partners to research and respond timely to consumer or regulatory agency complaints and grievances.
• Develop and maintain procedures and guidelines for handling customer grievances and complaints, including proper documentation, investigation, and resolution.
• Maintain a complaints and grievance tracking log to manage active complaints as well as to create an archive of past complaints.
• Collaborate with other departments, including Sales, Customer Service, and Claims, to gather information and address customer complaints effectively.
• Analyze complaint data to identify trends and areas for improvement, providing regular reports to the Director of Compliance and other stakeholders.
• Develop and deliver training programs for staff to ensure understanding and adherence to grievance and complaints processes, as well as regulatory requirements.
• Monitor changes in state and federal regulations related to grievance and complaints processes, updating company policies and procedures as needed.
• Serve as the primary contact for regulatory agencies and insurance carriers regarding customer grievances and complaints, ensuring prompt and professional communication.
• Maintain a high level of customer satisfaction by ensuring complaints are resolved fairly and efficiently, while continuously seeking ways to improve the customer experience.
• Perform other duties and responsibilities as assigned by the Director of Compliance.

Qualifications:

• Bachelor's degree in Business, Healthcare Administration, or a related field with a minimum of 3 years of experience in health insurance (with a focus on complaints, customer service, or grievance handling), or a JD.
• Strong knowledge of state and federal regulations related to health insurance grievances and complaints.
• Excellent communication and interpersonal skills (both written and oral), with the ability to interact effectively with customers, employees, and regulatory agencies.
• Strong analytical and problem-solving abilities, with the capacity to identify trends and implement process improvements.
• Proficiency in Google or Microsoft Office Suite, including Excel, Word, and PowerPoint.
• Experience with grievance and complaints management software or case management systems is a plus.

Enhance Health provides equal employment opportunity to all applicants and employees. No person is to be discriminated
against in any aspect of the employment relationship due to race, religion, color, sex, age, national origin, disability, citizenship
status, marital status, veteran status or any other reason prohibited by law.

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