Customer Service Grievance Specialist

Job description

CUSTOMER SERVICE GRIEVANCE SPECIALIST

Under the general supervision of the Director of Customer Service, the Customer Service Grievance Specialist is responsible for assuring that DWIHN’s grievance process is carried out in accordance with local, state, and federal regulations, BBA, Mental Health Code mandates and MDHHS contract.

PRINCIPAL DUTIES AND RESPONSIBILITIES

• Assists with the development of grievance process and procedures in accordance with Federal Rules, MDHHS guidelines, Michigan Mental Health Code and DWIHN policies and procedures.
• Provides applicable Customer Service information, referral, and linkage.
• Provides oversight of telephone and walk-in-inquiries.
• Assists with the monitoring of the grievance process at DWIHN and contractor network to ensure compliance with established policies and procedures.
• Collaborates and coordinates with various internal/external entities to ensure that issues are addressed in accordance with mandated policies and procedures.
• Maintains the reporting mechanism that tracks and monitors DWIHN and contractor’s network complaints and grievances.
• Performs related duties as assigned.

REQUIRED EDUCATION:

A Bachelor’s Degree in Social Work, Psychology, Healthcare Administration, Health Management, Business Administration, Conflict Resolution or a related field.

REQUIRED EXPERIENCE:

Four (4) years of full-time paid experience in complex cross-functional dispute resolutions or enrollee/member relations.

OR

Four (4) years of full-time paid experience in a member facing Customer Service position.

REQUIRED LICENSE(S):

A valid State of Michigan Driver’s License with a safe and acceptable driving record.

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