Complaint Investigations Coordinator

Curative wants to change the view on what a health plan can be. Born out of the pandemic, we created a health plan reinvented for a post-pandemic world that is built around whole-person affordable preventive care featuring more benefits. Curative is looking for a Complaint Investigations Coordinator who is detail oriented and passionate about helping the company's overall success of health plan by processing complaints and grievances in a professional manner. This position is remote.

Essential Duties And Responsibilities

• Ensure complaints and grievances are captured, evaluated, reviewed, and investigated per Texas Department of Insurance and/or other state regulators
• Collaborate with internal departments such as Member Services, Provider Support, Care Navigators, Claims, Legal, Compliance, Pharmacy, and Utilization Management to identify factors necessary for optimal resolution if needed
• Maintain accurate information; ensure data collection, summarization, integration and reporting while maintaining confidentiality per HIPAA guidelines
• Utilize all available Curative resources to gather pertinent information regarding grievances and complaints
• Coordinate acknowledgement and resolution letters to members and/or providers through the virtual mailroom
• Work adhering to US regulatory and Quality System requirements (21 CFR 820, etc).
• This position assumes and performs other duties as assigned

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:

• Excellent attendance is critical to success in this position
• Internal candidates must have been in their current role for at least 6 months and have no performance or attendance actions in effect
• 2+ years experience in healthcare industry/insurance
• Proficient in working with Google Suites
• Ability to follow written and verbal direction while effectively handling multiple tasks with changing priorities
• Ability to understand and comply with federal, state and local regulations
• Knowledge of claims and prior authorizations
• Exceptional attention to detail and organizational skills

EDUCATION And/or EXPERIENCE

• Associate’s degree (A.A.) or 2+ years of experience in healthcare industry/ insurance

WORK ENVIRONMENT

• Remote position
• Must have password protected, stable internet access - stipend will be provided
• Work location must be secure with no distractions to perform duties for work from home and be private to maintain HIPAA compliance
• While performing the duties of this Job, the employee is regularly required to sit; use hands to handle or feel; talk; and hear
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus
• The employee is frequently required to reach with hands and arms
• Office equipment will be supplied including: PC, monitor, keyboard, mouse, headset
• We also request, with the exception of emergencies, that you do not request any time off within the first 120 days of employment. Any request within the first 120 days if approved will be unpaid
• For this position the percentage of expected Travel is: 0% of the time

TRAINING EXPECTATIONS

• You will attend a 4-5 week minimum remote training program
• Attendance is mandatory during the full training timeline for this role
• Training will be Monday through Friday 8:30am - 5pm PST
• You will be required to take regular open book competency and retention exams intermittently during all weeks of training. Passing grades are 90% or above.