About the role
About the role
The Grievance/Compliance Specialist is responsible for conducting thorough and impartial investigations into grievances, complaints, and incidents across company's operations. This role serves as the primary point of contact for grievance intake, case management, investigation, documentation, and resolution. The Compliance Specialist ensures all investigations meet regulatory standards, including Medi-Cal, PACE program requirements, California Department of Health Care Services (DHCS) guidelines, and internal policies.
Key responsibilities
- Receive, log, and triage grievances, complaints, and incident reports from participants, family members, staff, regulatory agencies, and other stakeholders.
- Conduct end-to-end investigations: gather and review relevant documentation (trip logs, driver records, dispatch data, medical authorizations), interview complainants, witnesses, and involved personnel, and analyze findings against applicable policies, contracts, and regulations.
- Prepare comprehensive investigation reports with factual summaries, findings, root cause analysis, and recommended corrective actions. Present findings to the Risk & Compliance Manager and relevant department heads.
- Track investigation timelines and ensure all cases are resolved within regulatory and contractual deadlines. Maintain a case management system with status updates and closure documentation.
- Identify patterns and trends across grievances and incidents. Provide data-driven recommendations for policy updates, training needs, and process improvements.
- Support the development and delivery of compliance training materials related to grievance handling, investigation procedures, and regulatory requirements.
- Assist in preparing responses to regulatory inquiries, audits, and surveys related to grievance and incident management.
- Collaborate with Operations, Human Resources, Client Care, and Business Development to ensure consistent application of policies and cross-departmental visibility into investigation outcomes.
- Maintain strict confidentiality of all investigation files and protected health information (PHI) in accordance with HIPAA and company policy.
- Stay current on applicable regulations (Medi-Cal, CMS, DHCS, CPUC, PACE) and industry best practices for healthcare transportation compliance and grievance resolution.
About you
- Methodical, detail-oriented approach to fact-finding
- Ability to produce clear, defensible written findings that support organizational accountability and continuous improvement
Qualifications
- At least 2 years experience in BPO
- Voice Account, medical or healthcare account is a plus.
- Amenable to work onsite in Filinvest / Eastwood for a shifting schedule.
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