Grievance and Appeals Representative
Logisticare - Los Alamitos, CA

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- Qualified candidates must have a high school degree or GED. Some college or customer service training preferred.


- Requires 2+ years customer service experience, preferably in a medical environment

- Prior front office medical experience, medical case management, and/or medical social work experience a plus


- Excellent customer service and phone skills

- Strong verbal communications, problem solving, time management and organizational skills

- Ability to accurately type 35+ corrected words per minute

- Ability to work independently or with a team a must

- Must be able to handle heavy phone volume

Environmental and Working Conditions:

- Entire work time is conducted in an office setting

Physical and Mental Requirements:

- Must be able to understand and follow complex instructions

Job Description:
LogistiCare is the nation's leading managed healthcare organization specializing in the management of healthcare transportation benefits. LogistiCare's client base consists of state and local government agencies (Medicaid agencies, transit authorities, school boards), managed care organizations and hospitals. LogistiCare is not a provider of transportation vehicles (we do not physically own vehicles). Instead, LogistiCare manages a network of transportation providers and provides the administrative infrastructure to authorize services and provide billing and claims payment functionality allowing LogistiCare to offer a complete outsourcing solution to our clients.

We seek a Quality Assurance (QA)Representative. The QA Representative works with customers, subcontractors and LogistiCare staff to ensure quality service. The QA Representative also establishes positive and effective working relationships with customers, providers and agencies to establish superior customer service and to reduce the number of official complaints by performing the following duties:

- Records and initiates investigation of complaints

- Follow-up with members about complaints.

- Prepare weekly / monthly / quarterly reports for the management of complaints and grievances

- Manages grievances from healthplans

- Initiates corrective actions

- Work closely with Los Alamitos Operations

- Performs other duties as assigned

We are an Equal Opportunity Employer.

Logisticare - 12 months ago - save job - block
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About this company
135 reviews
Compassion. Accuracy. Reliability. Efficiency. Extra CARE makes all the difference... There is more to non-emergency transportation...