Complaints & Grievances Resolution Specialist - BALTIMORE, MD (504486)
UnitedHealth Group - Maryland

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General Summary:
The Complaints & Grievances Resolution Specialist reports directly to the Manager Consumer Affairs and is responsible for the Medicare grievance and complaint process. This position also interacts via telephone and written correspondence with Medicare members by answering questions/inquiries regarding the Medicare grievance process.

Primary Responsibilities:
· Interacts with Medicare members and providers via the telephone to explain the grievance process. Correspond in writing with members and providers regarding grievance process and resolutions.

· Record, investigate and resolve customer and provider complaints and grievances as detailed in the Complaint/Grievance procedure narrative.

· Maintains grievance and complaint investigation files.

· Tracks grievances as required by CMS to ensure reporting timelines are met.

· Assists in the education of new customers and in the re-education of existing customers to the proper complaint/grievance procedures of the health plan.

· Tracks and follow-ups on complaint and grievances, utilizing on-line systems and procedures, according to the established guidelines.

· Analyze and identify trends and provides reports as necessary

UnitedHealthcare Medicare & Retirement is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

Imagine joining a group of professionals and clinicians who are working to improve health care for people over 50. Consider the influence you can have on the quality of care for millions of people. Now, enhance that success with enthusiasm you can really feel.

That's how it is at UnitedHealthcare Medicare & Retirement. Everyday, we're collaborating to improve the health and well being of the fastest growing segment of our nation's population. And we're doing it with an intense amount of dedication.

Here, you will discover a culture that grows through challenge. That evolves by being flexible. That succeeds by staying true to our mission to make health care work effectively and efficiently for seniors. Put your best to work for us, and discover extraordinary opportunities for growth.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.


Required Knowledge, Skills, and Abilities:
· Bachelor’s degree or equivalent combination of education and experience.

· Minimum 2-4 years of experience in a healthcare setting, preferably in a government programs (Medicare, Medicaid) product.

Knowledge, Skills and Abilities:
· Proficiency in MS Office Suite.

· Expertise in administering the Medicare complaint and grievance process.

· Good organizational and time management skills.

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