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Posted: Friday, March 2, 2018 8:46 PM

Description: Supports regional member retention goals through compliant management of complaints, many of which are complex, multifaceted or sensitive, including written and verbal communication with customers, research, documentation and resolution in collaboration with health care providers, Care Delivery and Health Plan managers. Improves the Region's performance on complaint documentation, research and resolution in compliance with state/federal regulations, program office, regional and department quality and timeliness standards. Improves customer satisfaction levels by providing timely, appropriately sensitive, professional responses to complaints.

Essential Responsibilities:
  • Manages high profile and often complex customer complaint cases by reviewing and discerning relevant issues and coordinating research with health care providers, Care Delivery and health plan managers. Upon compilation of pertinent information, develops appropriate verbal and/or written customer responses. Provides clear and concise written case summaries which are made available for both internal audits and audits by state and federal regulatory agencies including, The Centers for Medicare and Medicaid Services (CMS). Collaborates with providers, managers and customers to negotiate satisfactory complaint resolution. Communicates with and diffuses angry customers in highly charged, sometimes emotional situations.
  • Provides information for trending and specific complaint resolution interventions. Helps to identify regional and local process improvements, which if implemented would increase satisfaction of members, patients, purchasers, and other customers (measured primarily through a decrease in complaint volumes).
  • Provides feedback and input on CCRC policies and procedures. Works with department managers and performance auditors specifically to create training programs and tools, processes and interventions which are effective in improving compliance with documentation and resolution of complaints.
  • Participates in preparation for Member Relations/CCRC internal, regulatory and accreditation audits and special projects and assignments as requested. Implements any corrective actions necessary to address internal and external audit findings.

    Basic Qualifications:
  • Minimum of four (4) years experience working effectively with customers in a complaint or customer service type of department.
  • Minimum of three (3) years working in a health care or insurance setting disseminating complex information orally and in writing to customers, managers, staff and providers.
  • Minimum of one (1) year experience in a position using medical terminology to determine what treatment or level of care was provided or to interpret information for further dissemination. Education

  • Bachelor's degree in education, business, health care administration, communication, or other similar field OR four (4) years of experience in a directly related field.
  • High School Diploma or General Education Development (GED) required. License, Certification, Registration

  • N/A

    Additional Requirements:

  • Demonstrated ability to use MicrosoftWord and other electronic systems.

  • Excellent oral communication skills; demonstrated ability to negotiate in highly charged emotional situations, defuse anger and resolve conflicts both in person and over the telephone by utilizing a variety of mediation, conflict resolution and negotiation methods.

  • Excellent writing skills; demonstrated ability to summarize complex and sensitive information, and write reports/memos/letters in a clear, concise, non-judgmental, non-threatening and effective manner.

  • Excellent judgment, strong analytical and problem-solving skills; demonstrated ability to interpret complex medical, contractual or legal material, identify important issues, assess completeness or adequacy of information, make independent decisions under a framework of general policy and develop effective recommendations.

  • Strong customer service orientation.

  • Excellent time management/prioritization skills; demonstrated ability to handle multiple tasks with shifting priorities, successfully meeting deadlines with a high volume of work.

  • Highly developed ability to influence up and at peer level for successful results.

  • Ability to assimilate and apply complex and diverse state and federal regulations, accreditation requirements, and similar material.

    Preferred Qualifications:

  • Intermediate/competent knowledge of internal computer systems including CIDARS, Common Membership (CM), Lotus Notes, Healthconnect, Macess and Diamond.
  • Working knowledge of Kaiser Permanente policies and procedures.
  • Knowledge of care delivery services, policies and procedures.
  • Working knowledge of Medicare and OR/WA Medicaid, OR/WA regulations especially related to dispute resolution.

  • Bachelor's degree in education, business, health care administration, communication, or other similar field.

    Primary Location: Oregon,Portland,Kaiser Permanente Building 500 NE Multnomah St.
    Scheduled Weekly Hours: 40
    Shift: Day
    Workdays: Mon -Fri
    Working Hours Start: 8:30
    Working Hours End: 5:00
    Job Schedule: Full-time
    Job Type: Standard
    Employee Status: Regular
    Employee Group/Union Affiliation: Salaried, Non-Union, Exempt
    Job Level: Individual Contributor
    Job Category: Customer Services
    Department: Customer Concern Resolution Center
    Travel: Yes, 5 % of the Time
    Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

    External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.
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    Associated topics: adult, behavioral, behavioral health, clinician, disabilities, domestic, hcpc, insights, lcsw, substance


  • • Location: Portland

    • Post ID: 27114942 portland is an interactive computer service that enables access by multiple users and should not be treated as the publisher or speaker of any information provided by another information content provider. © 2018