Complaints Investigator – Consumer Services in Albany, NY

Item 1066

Summary:

The Healthcare Organizational Operations Administrator (HOOA) will assist the Team Lead and Unit Manager with the day-to-day activities associated with the Intake Unit, including but not limited to the receipt and intake of Medicaid enrollee and provider complaints and inquiries. This position will respond to and track all written, verbal, and electronic complaints and inquires made by enrollees, health care providers and their designees.

These responsibilities include:

• Respond professionally to complaints and inquiries from the Bureau of Consumer Services (BCS) complaint phone line, fax and complaint email boxes. The HOOA will collect relevant information from the complainant and accurately enter the information into the BCS Complaint Database or refer caller to the responsible government agency.
• Use all available resources to accurately respond to allegations raised by complainants.
• Elevate complaints to the BCS Investigation Unit appropriately, ensuring all relevant information is included in the complaint file.
• Work collaboratively with health insurance plans, healthcare providers, consumers, advocates, designees and government agencies to ensure appropriate action is being taken and that the complainant understands their rights.
• Provide current and accurate guidance to complainants regarding Medicaid Managed Care services and benefits.
• Maintain an organized work environment to ensure work is accomplished efficiently and effectively.
• Support all work of the Intake Unit and assist in special projects as requested by the Team Lead or Unit Manager.

Basic Qualifications:

• High School Graduate or Equivalent
• 3 Years of Administrative Experience
• The ability to function in a team environment.
• The ability to take initiative and ask questions.
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Preferred Qualifications:

• Call Center Experience
• Knowledge of NYS government sponsored health programs;
• Knowledge and experience using eMedNY (NYS Medicaid Eligibility System) and Back Office (NYSOH); Experience in investigating issues in enrollment and eligibility and Managed Care Plan regulatory compliance; Knowledge of medical terms and procedures; Proficiency in Microsoft Office (Excel).

Compensation for roles at Staffing Solutions Organization LLC (SSO) varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, SSO provides the following reasonable range of compensation for this role: [compensation range here]. In addition, SSO provides a range of benefits for this role.

Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.