Grievance Customer Service Lead Representative

The Grievance team manages Cigna Healthcare - Medicare/Medicaid grievances that are presented by our member’s or their representatives pertaining to the authorization of or delivery of clinical and non-clinical services. Grievance works in collaboration with divisions within and outside the organization to resolve issues in a timely and compliant manner.

Grievances coordinator position is focused on the processing of Medicare customer grievances. This associate may screen incoming complaints received orally or in writing, conducting root cause analysis as needed, creating an action plan, coordinating and communicating resolutions, as well as documenting systems in detail with case notes related to Customer grievances with in CMS guidelines.

Duties and Responsibilities:

• Grievance Coordinator is responsible for corresponding with members, providers and regulators regarding decisions and actions.
• Works collaboratively with the Claims, Customer Service, Appeals, and Medical Management Departments.
• Communicate, collaborate and cooperates with internal and external business partners.
• Adheres to all Compliance/Program Integrity requirements and complies with HIPAA Regulatio...