Soma Capital Portfolio Jobs

Complaint Investigations Coordinator

Curative

Curative

Remote
Posted on Tuesday, June 11, 2024

Complaint Investigations Coordinator

Department: Customer Success
Reports To: Health Plan Operations & Grievance Manager
FLSA Status: Non Exempt


SUMMARY

Curative wants to change the view on what a health plan can be. Born out of the pandemic, we created a health
plan reinvented for a post-pandemic world that is built around whole-person affordable preventive care featuring
more benefits. Curative is looking for a Complaint Investigations Coordinator who is detail oriented and
passionate about helping the company's overall success of health plan by processing complaints and grievances in
a professional manner. This position is remote.


ESSENTIAL DUTIES AND RESPONSIBILITIES
● Ensure complaints and grievances are captured, evaluated, reviewed, and investigated per Texas
Department of Insurance and/or other state regulators
● Collaborate with internal departments such as Member Services, Provider Support, Care Navigators,
Claims, Legal, Compliance, Pharmacy, and Utilization Management to identify factors necessary for
optimal resolution if needed
● Maintain accurate information; ensure data collection, summarization, integration and reporting while
maintaining confidentiality per HIPAA guidelines
● Utilize all available Curative resources to gather pertinent information regarding grievances and
complaints
● Coordinate acknowledgement and resolution letters to members and/or providers through the virtual
mailroom
● Work adhering to US regulatory and Quality System requirements (21 CFR 820, etc).
● This position assumes and performs other duties as assigned


QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The
requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable
accommodations may be made to enable individuals with disabilities to perform the essential functions:
● Excellent attendance is critical to success in this position
● Internal candidates must have been in their current role for at least 6 months and have no performance or
attendance actions in effect
● 2+ years experience in healthcare industry/insurance
● Proficient in working with Google Suites


CONFIDENTIAL: Information contained in this document is confidential and proprietary to Curative Inc. It may not be reproduced for any reasons
without written permission from Curative Inc. All rights of design, invention, and copyright are reserved.


● Ability to follow written and verbal direction while effectively handling multiple tasks with changing
priorities
● Ability to understand and comply with federal, state and local regulations
● Knowledge of claims and prior authorizations
● Exceptional attention to detail and organizational skills


EDUCATION and/or EXPERIENCE
● Associate’s degree (A.A.) or 2+ years of experience in healthcare industry/ insurance

CERTIFICATES, LICENSES, REGISTRATIONS
N/A
WORK ENVIRONMENT
● Remote position
● Must have password protected, stable internet access - stipend will be provided
● Work location must be secure with no distractions to perform duties for work from home and be private to
maintain HIPAA compliance
● While performing the duties of this Job, the employee is regularly required to sit; use hands to handle or
feel; talk; and hear
● Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral
vision, depth perception and ability to adjust focus
● The employee is frequently required to reach with hands and arms
● Office equipment will be supplied including: PC, monitor, keyboard, mouse, headset
● We also request, with the exception of emergencies, that you do not request any time off within the first
120 days of employment. Any request within the first 120 days if approved will be unpaid
● For this position the percentage of expected Travel is: 0% of the time

TRAINING EXPECTATIONS
● You will attend a 4-5 week minimum remote training program
● Attendance is mandatory during the full training timeline for this role
● Training will be Monday through Friday 8:30am - 5pm PST
● You will be required to take regular open book competency and retention exams intermittently during all
weeks of training. Passing grades are 90% or above.