Job Description
Under the supervision of the Director of Quality, assists individual members with addressing issues and concerns; serves as a resource for the Grievance and Appeals function. Responsible for coordinating and facilitating resolution of grievances and appeals initiated by or on behalf of program members in accordance with written policies and procedures, criteria and standards established by the Company. This position interfaces with the Department of Health Services (DHS), the Division of Hearings and Appeals (DHA), Ombudsman Program, the State’s External Review organization and federal agencies as required. Supports the achievement of member outcomes and goals by delivering support services to employees, providers, members, and/or other stakeholders. Identifies and/or participates in efforts to continuously improve the quality of support services. Understands his/her connection to our member-centered culture.
Hard Skills
- Grievance and Appeals resolution
- Policy and procedure adherence
- Interfacing with DHS, DHA, Ombudsman Program, and federal agencies
Soft Skills
- Problem-solving
- Communication
- Continuous improvement
Work Site
This is a fully on-site position in Brookfield, Wisconsin.
Work Environment
Collaborative, member-centered culture
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
Diversity, Equity & Inclusion
At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:
- Hiring diverse talent
- Maintaining an inclusive environment through persistent self-reflection
- Building a culture of care, engagement, and recognition with clear outcomes
- Ensuring growth opportunities for our people
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.