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Customer Solution Center Appeals And Grievances Quality Auditing Specialist II
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$67,186 - $107,498 a year
Full-time
- Job SummaryThe Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for assisting the Appeal and Grievances Compliance, Training and QA Manager to develop a successful and cohesive unit with a high level of productivity and focus on implementing, executing, tracking, and assessing targeted and random audits for non-clinical grievance and appeal case documentation.
- Ensure A&G Non-Clinical staff is following all Regulatory guidelines, internal P&Ps, Desktop Procedures, in a consistent and accurate manner.
- This position will focus on quality review of non-clinical grievance and appeals cases for all line of business (LOB) to identify areas of improvement to assist the department in increasing positive audit outcomes and improved Customer Service to L.A. Care’s membership.
- This position will keep the QA Manager aware of trends, deficiencies and any potential issues that arise for review and evaluation by the Management Team. DutiesFocus on quality review of grievance and appeals cases for all LOB to identify areas of improvement to assist the department in increasing positive audit outcomes and improved Customer Service to L.A. Care’s membership.
- Track and trend QA reviews, analyze results from scorecards and recommend quality improvements for the Appeal and Grievances Department.
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