Grievance Associate

Welcome to the Latest Job Vacancies Site 2025 and at this time we would like to inform you of the Latest Job Vacancies from the Amerihealth Caritas with the position of Grievance Associate which was opened this.

If this job matches your qualifications, please send your application directly through our latest Job site. Indeed, every job is not easy to apply because it must meet several qualifications and requirements that we must meet in accordance with the standard criteria of the Company who are looking for potential candidates to work. Good job information Grievance Associate below matches your qualifications.

Your career starts now. We are looking for the next generation of healthcare leaders.

At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to connect with you.

Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Summary:

Working with the Grievance Supervisor or Grievance Coordinator, the Grievance Associate ensures that all problems, complaints, and grievances presented by Plan members or their representatives, are resolved in accordance with established policies and procedures as well as NCQA, Federal, and State guidelines.;;

Responsibilities:

• Under the supervision of the Grievance Supervisor or Grievance Coordinator, act as a Member advocate and communicate with medical facility administrators, providers, physicians, and all applicable AMFC departments, to interpret and enhance understanding of the Plan's policies and procedures relative to complaints and grievances;
• Accurately document, in the appropriate computer system, all correspondence associated with the grievance; thoroughly research questions and issues in order to provide an accurate explanation
• Track and report turnaround time, and keep abreast of all cases to ensure that the 30-day time limit for case resolution is met for 100% of all grievances
• Provide complaint/grievance training for the Plan's staff in the base unit and all supporting departments
• Perform other related duties and projects as assigned;

Education/Experience:;

• High School Diploma or equivalent required;;Associate's degree preferred
• Minimum one (1) year of experience in direct contact with members in relation to any complaints and/or grievances
• Experience handling escalated telephone calls
• Experience with Contact Center and Workforce Management technology (scheduling, adherence, quality monitoring)
• Effective communication (listening, verbal, and written) skills
• Strong decision-making, problem-solving, and telephone skills
• Working knowledge of Microsoft Office to include Word, Excel and Outlook
• General understanding of Macess/EXP documentation system
• Ability to work both independently and in a team environment
• Ability to respond to inquiries in a timely manner

Diversity, Equity, and Inclusion

At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

Flexible work solutions include remote options, hybrid work schedules, competitive pay, Paid Time Off (PTO), including holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k), tuition reimbursement, and more.

How to Submit an Application:

After reading and knowing the criteria and minimum requirements for qualifications that have been explained from the Grievance Associate job info - Amerihealth Caritas Hybrid work in Philadelphia, PA 19113 above, thus jobseekers who feel they have not met the requirements including education, age, etc. and really feel interested in the latest job vacancies Grievance Associate job info - Amerihealth Caritas Hybrid work in Philadelphia, PA 19113 in 2025-05-26 above, should as soon as possible complete and compile a job application file such as a job application letter, CV or curriculum vitae, FC diploma and transcripts and other supplements as described above, in order to register and take part in the admission selection for new employees in the company referred to, sent via form this bottom.