Grievance Coordinator Resume

Samantha Gray

North Highlands CA 95660

(916) 987-6543

[email protected]

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Job Objective

To obtain a Grievance Coordinator position that fully utilizes my experience and abilities.

Work Experience:

Grievance Coordinator, May 2004 – Present

Fox, Staten Island, NY

  • Supported Risk Management functions by conducting referral investigations, researching grievance requests, and trending events.
  • Provided prompt, accurate, detailed responses of resolutions in accordance with Centers for Medicare and Medicaid Services (CMS) guidelines.
  • Ensured accurate and timely completion of each case.
  • Provided timely status updates concerning requests.
  • Provided trend data and other reports to the Performance Improvement Council.
  • Collaborated with hospital leadership for investment implementation through timely resolution and process improvement methods.

Grievance Coordinator, March 2002 – April 2004

Intel,inc., Staten Island, NY

  • Monitored grievance process to ensure compliance with federal and state regulations.
  • Made recommendations on process and policy modifications and improvements.
  • Compiled information and data from, analyzed information, prepared written summaries, and made recommendations.
  • Served as the primary resource and point of escalation for the Grievance Coordinator.
  • Assisted in training and educating Alliance staff on the grievance process.
  • Developed and maintained Grievance and Member Services Department policies, procedures and processes, and compliance assessments.

Summary of Qualifications:

  • Extensive customer service experience in health insurance environment
  • Excellent knowledge CMS, joint commission regulations and grievances
  • Sound knowledge of Medicaid Managed Care laws, regulations and benefits
  • Ability to document oral information received into accurate and concise written narratives
  • Profound knowledge of hospital operating systems
  • Proficient with PC and MS word and excel
  • Excellent organization and follow through skills
  • Strong critical thinking, object problem solving and prioritization skills
  • Outstanding time management skills
  • Remarkable ability to meet deadlines


Bachelor of Science in Nursing, Cardinal Stritch University, Wisconsin, WI