Customer Advocate Specialist
 Health Care Service Corporation | |
life insurance, parental leave, paid time off, paid holidays, tuition reimbursement, 401(k)
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 United States, Tennessee, Nashville | |
 Jul 26, 2025 | |
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At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary The Grievance team manages Cigna Medicare/Medicaid grievances that are presented by our member's or their representatives pertaining to the authorization of or delivery of clinical and non-clinical services. Grievance works in collaboration with divisions within and outside the organization to resolve issues in a timely and compliant manner.Grievances coordinator position is focused on the processing of Medicare customer grievances. This associate may screen incoming complaints received orally or in writing, conducting root cause analysis as needed, creating an action plan, coordinating and communicating resolutions, as well as documenting systems in detail with case notes related to Customer grievances with in CMS guidelines. Duties and Responsibilities: *Grievance Coordinator is responsible for corresponding with members, providers and regulators regarding decisions and actions. *Works collaboratively with the Claims, Customer Service, Appeals, and Medical Management Departments. *Communicate, collaborate and cooperates with internal and external business partners. *Adheres to all Compliance/Program Integrity requirements and complies with HIPAA Regulations and must meet/exceed compliance and production goals. *Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency. *Supports department-based goals which contribute to the success of the organization. CANDIDATE QUALIFICATIONS: *Bachelors or associates degree in related field; in lieu of a degree, a high school diploma and two years in a Medicare, Medicaid managed care environment investigating and resolving Grievances, preferred. *One year of health insurance/managed care experience knowledge of healthcare terminology preferable. *Strong written and verbal communication skills, PC proficiency to include Microsoft office products. *One year of health insurance/managed care experience performing Appeals and Grievances functions preferred. *Will consider managed care associates with three years of experience in customer service, call center or claims processing skills and knowledge of healthcare delivery. *Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment. *Demonstrated written communication skills, time management, priority setting, problem solving and organizational skills. *Demonstrated ability to converse with and collaborate with physicians and physician personnel. *Ability to identify and define problems, collect data/information, establish facts, and draw valid conclusions and provide resolution. *Ability to track and manage case load effectively in Grievance tracking system *Must be able to work independently and under pressure related to tight time-frames JOB REQUIREMENTS: * 1+ year grievance experience * 1+ year Medicare experience Hybrid/Flex: Rotating schedule of 2 weeks remote followed by 1 week in office. Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! Pay Transparency Statement: At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards. The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plansubject to the terms and the conditions of the plan. HCSC Employment Statement:We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. Base Pay Range$18.10 - $37.10 | |