Lumeris Associate Communications Writer, Grievances in St. Louis, Missouri
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Associate Communications Writer, Grievances
The Associate Writer is an important part of the Medicare Grievances Program, which is the heartbeat of Plan operations and a direct insight to member experience. This role is responsible for drafting, reviewing, or revising member and provider notifications related to member grievances (complaints) to ensure that all complaints are properly investigated and notifications are accurate, complete, and member-friendly.
Drafts, reviews, and revises resolution letters to members and letters of inquiry to providers and vendors.
Uses basic understanding of medical terminology and jargon to help identify and write/review potential quality of care concerns a in easy to understand language.
Rapidly develops and maintains a thorough and up-to-date understanding of organizational functions and processes, client relationships, and Medicare requirements for all aspects of Health Plan Grievances.
Completes letter review, including reviewing the case and understanding the basis of the member complaint, the investigation the department conducted, any relevant information collected or otherwise available, and the specific resolution for the member.
Documents deficiencies in draft communications and delivers feedback to respective team members.
Tracks and trends results of letter review to assist in identifying ongoing training opportunities or specific performance issues.
Bachelors degree and 1+ year of experience creating content for patients, members, or general public; experience in Medicare Advantage, Appeals & Grievances, and/or other health plan operations (e.g., Claims, Customer Service, Enrollment) can be beneficial
Firm working knowledge of medical terminology and medical care (i.e. health plan, provider office, or hospital system); preferred experience as a nurse or in delivery of medical care
Good logical, analytical, critical thinking, investigatory, organizational, decision making and problem-solving skills; ability to remain objective and separate facts from opinions
Skilled problem-solver with the ability to take on moderately complex problems and achieve a solution within a reasonable amount of time
Satisfactory time-management skills with the ability to meet deadlines and prioritize work in a fast-paced environment
Proficient written communication skills and capable of drafting general and specific content for highly technical and complex issues in a form and manner that is easily understood by patients or the general public
Good interpersonal and customer service skills with the ability to articulate resolutions and communicate contrary facts or potentially upsetting information to the member
Ability to address administrative requirements or provide education on plan rules or benefit limitations in an understanding and empathetic tone
Ability to deliver frank and accurate feedback to team member regarding reviewed correspondence
- While performing the duties of this job, the employee works in normal office working conditions.
- The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.
Lumeris is an EEO/AA employer M/F/V/D.
St. Louis, MO
Join Our Growing Team!
Lumeris is a value-based care managed services operator for health systems and providers seeking extraordinary clinical and financial outcomes. Lumeris aligns providers and payers across populations with technologies, processes, behaviors and information to achieve high-quality, cost-effective care with satisfied consumers — and engaged physicians.
Lumeris with Essence Healthcare, its inaugural client and learning laboratory with more than 60,000 Medicare members in Missouri and Illinois, has averaged a CMS rating of 4.5 Stars for the last ten years and produced the highest consumer and physician satisfaction scores in the industry along with significantly better clinical outcomes and lower costs. For more information, go to www.lumeris.com.
Why Join Lumeris?
At Lumeris, you will be part of team that is focused on solving the nation’s healthcare problem, and you will be able to contribute to our purpose. Our environment is fast-paced, change-oriented and focused on growth and employee engagement. At Lumeris, we know that talent is best utilized when given the opportunity to succeed. That is why we have removed the boundaries that inhibit success and focus on fostering an environment that allows employees to utilize their talents.