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Customer Solution Center Appeal and Grievance Compliance Advisor

On-site Full-time

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Experience Level

Mid to Senior

Qualifications

Applicants must possess a minimum of 5 years of experience in regulatory auditing, specifically in Appeals & Grievances, Call Center operations, and Enrollment processes within a healthcare context. Familiarity with Medi-Cal and Medicare in a managed care environment is essential. A Bachelor's Degree is required; however, equivalent education and/or experience may be considered in lieu of a degree.

About the job

Join our dynamic Customer Solution Center as a Compliance Advisor specializing in Appeals and Grievances. In this pivotal role, you will lead the execution, oversight, and monitoring of essential guidelines and protocols to ensure our preparedness for all regulatory audits. Collaborating closely with CSC management, you will devise a robust auditing strategy that encompasses various end-to-end processes within the CSC framework, including the accuracy and timeliness of enrollment processing, issuance of I. D. Cards and member materials, outbound health risk assessment calls for Seniors and People with Disabilities, and the management of Appeals and Grievances across all service lines.

 

Your responsibilities will include the continuous advancement and maintenance of our compliance program, which encompasses policy development, training initiatives, and enhancements to compliance-related processes. You will conduct targeted, focused, and random audits to ensure compliance with all member interaction protocols and outcomes, providing management with actionable recommendations and corrective measures as needed.

 

As a key stakeholder in audit readiness, you will perform comprehensive audit procedures, identify issues, develop assessment criteria, analyze evidence, and meticulously document business processes. Your role involves direct communication with management through written reports and presentations, and you will assist in document preparation for both regulatory and internal audits.

About CCG Business Solutions

At CCG Business Solutions, we believe that success is rooted in individual potential. Since 2007, we have been dedicated to providing innovative business solutions and talent placement services that connect purpose to business goals. We are currently seeking a skilled Customer Solution Center Appeal and Grievance Compliance Advisor to join our team and contribute to our mission of excellence in service delivery.

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