Mastech Digital provides digital and mainstream technology staff as well as Digital Transformation Services for leading American Corporations. We are currently seeking a HR Disability Case Manager for our client in the Healthcare domain. We value our professionals, providing comprehensive benefits, exciting challenges, and the opportunity for growth. This is a Contract position and the client is looking for someone to start immediately.
Duration: 6 Months Contract (possible extension)
Location: Fresno, CA
Compensation: Best Market Rates
Role: HR Disability Case Manager
Primary Skill: MS Excel
Role Description: The HR Disability Case Manager would need to have at least 4+ years of experience.
Major Responsibilities/Essential Functions:
- Participate in managing the organization's complaint and grievance process.
- Accountable for investigation of all issues, including collection and documentation of appropriate data. - Identify and address specialty/flagged cases and follow appropriate processes for different types of cases.
- Communicate with a diverse set of internal and external clientele to achieve excellent results in the areas of complaint and grievance handling, compliance, documentation and enhancement of the member experience.
- Partner with and outreach to internal staff, other MS Departments, managers and physicians to resolve issues as quickly as possible.
- Research, resolve and communicate complaints and grievances filed by members and communicate decisions appropriately back to member or their authorized representatives.
- Ensure that complaints and grievances are processed in accordance with regulations, compliance standards and policies and procedures.
- Meet timeframes for performance while balancing the need to produce high quality work related to complex and sensitive member issues.
- Ensure integrity of departmental database by thorough, timely and accurate entry, consistent with regulatory protocols and effectively manage case resolution inbox every day.
- Participate in departmental meetings, trainings and audits as requested.
- Answer questions and manage members on existing / open cases
- Escalate issues to management as appropriate to maintain compliance.
Minimum Work Experience and Qualifications:
- Two years’ experience in a service related industry, call center experience preferred.
- Excellent interpersonal, verbal and written communication skills.
- Ability to work with peers in self-managed teams.
- Ability to prioritize work and ensure all compliance elements are met.
- Demonstrated conflict resolution and mediation skills with ability to secure action from multiple stakeholders.
- Ability to use sound judgment and to handle complex issues independently, but with the knowledge and ability to escalate and ask for help when needed.
- Demonstrated ability to work in a time-sensitive environment involving patients, family members and advocates.
- Extensive working knowledge of personal computers to include Windows based software applications, MS Word, etc. (added)
- Ability to multitask and manage time in order to perform well on long term projects while being flexible enough to assimilate short term projects on an ongoing basis.
- Must be able to work in a Labor/Management Partnership environment.
Preferred Work Experience and Qualifications:
- Two years’ experience in a complex health care environment preferred.
- Strong working knowledge of federal and state regulations, laws and accreditation standards related to health care and managed care organizations.
- Knowledge of member complaint and grievance processing preferred.
- Competent working knowledge of client Health Plan benefits plan/contracts/systems strongly preferred.
- Educational requirement - high school diploma or GED required. Some college preferred.
Education: High School Diploma/ Bachelor’s degree in Computer Science, Electrical/Electronic Engineering, Information Technology or another related field
Experience: Minimum 4+ years
Relocation: This position will not cover relocation expenses
Local Preferred: Yes
Recruiter Name: Pallavi Mishra
Recruiter Phone: 877.884.8834 (Ext: 2248)
Equal Employment Opportunity
Minimum Education Required: Bachelor
Years of Experience Required: 3-5 Years
Expected Travel Time: None