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GRIEVANCE & COMPLAINTS GATEKEEPER

We are searching for a Grievance & Complaints Gatekeeper, to join a Healthcare Payment business in Ohio. 


JOB TITLE

Grievance & Complaints Gatekeeper


LOCATION

Cleveland, Ohio


SALARY

Up to $50,000 + bonus and 'best-in-class' healthcare


REPORTS TO

Director, Customer Service and Virtual Card Operations


ROLE PURPOSE


Our client is looking for a dedicated Support Grievance Gatekeeper. The Gatekeeper role is critical in maintaining the highest standards possible for agents to identify and resolve member complaints and grievances properly. The gatekeeper also serves as a resource for clients should they need assistance resolving a member grievance.


RESPONSIBILITIES


  • Review contact center documentation to ensure agents properly identify complaints from callers.

  • Reclassify incorrectly listed complaints, and ensure reporting is updated to clients when applicable

  • Respond to client requests for information when related to member complaints.

  • Assist in coaching agents who need assistance better identifying and properly resolving member complaints

  • Work closely with operations management to support additional resources for better efficiency in resolving complaints from members. 

  • Collaborate with the learning and development department to update and develop training materials.

  • Collaborate with the compliance team to ensure compliance in resolving member complaints.

  • Perform root cause analysis related to failures in the complaint handling process.

  • Monitor customer feedback and common trends to identify opportunities to serve members better

  • Develop and maintain a positive and productive work environment for the contact center team.


QUALIFICATIONS


  • Bachelor's degree or 5+ years of support operations experience

  • Previous experience in operations working within regulatory standards

  • Previous contact center experience

  • Experience with industry-standard contact center software and related telephony systems

  • Experience working with external customers, including presentations and root cause analysis discussions

  • Experience coaching and driving operational efficiency with contact center agents

  • Healthcare experience preferred

  • Ability to travel up to 10%


Preferred Skills:

  • Healthcare EDI standards such as 835s.

  • Job scheduling tools.

  • VMware.

  • Crystal Reports.

  • Automated testing tools.

  • ETL tools for data mapping.


WORKING CONDITIONS


This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.


Management duties may require travel to Client facilities to support presentations and strategy discussions.


The job description outlined above reflects general details as necessary to describe the primary functions of this job, the level of knowledge and skill typically required, but should not be construed as an all-inclusive listing of work requirements. Individuals may be asked to perform duties other than those mentioned above in order to cover absences or relief in the appropriate department to equalize peak work periods or otherwise balance the workload.


PHYSICAL ENVIRONMENT


While performing the duties of this job, employees are regularly requiredto sit, walk and stand; talk or hear, both in person and by telephone; use hands repetitively to operate standard officeequipment; reach with hands and arms and lift up to 25 pounds. Standing for extended periods of time may be required during training delivery.


IF YOU'RE INTERESTED IN APPLYING FOR THIS ROLE, PLEASE SEND ME YOUR CV USING THE BUTTON BELOW AND QUOTE THE JOB TITLE AS A REFERENCE.

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