Position Title: Grievance Specialist
Salary Group: B18
Posting Date: 3/5/2021
Posting Number: 1288
Salary Type: Monthly
Closing Date: Open Until Closed
Class Number: 1571
Salary Range: $4,166.00 - $4,500.00
Number of Positions: 1

Essential Functions

Our mission is simply stated:  ERS offers competitive benefits to enhance the lives of its members.  Each team member across the agency contributes to our ongoing success.

The Grievance and Appeals team in the Group Benefits Division processes grievance and appeals from program participants regarding benefits under the Texas Employees Group Benefits Program (GBP).  The Grievance Specialist will support in functions related to the administration of the grievance and appeals processing that include the development or the implementation of technical, functional and problem solving solutions in cooperation with the Grievance Administrator.

Essential Functions includes, but is not limited to
  • Performs preliminary research and analysis for second level appeals
  • Performs initial review of second level appeals;
  • Ensures carrier or internal divisions have followed plan document guidelines for eligibility and enrollment rules
  • Compiles and analyzes data and prepares benefit calculations
  • Provides administrative and technical support to the Grievance Administrator
  • Prepares grievance reports, studies, forms, and documents
  • Prepares correspondence for the Grievance Administrator throughout all phases of the grievance process including the daily preparation and review of grievance requests
  • Maintains the Grievance Tracking System (GTS) to ensure all grievances are logged into the system timely and accurately; provides monthly reporting
  • Assists in managing Recorded Audio Statement and Direct Call processes 
  • Assists with the Grievance Review Committee (GRC)
  • Assists with responses to inquiry requests
  • Responds to inquiries from employees and retirees regarding claims and GBP coverage questions and disputes
  • Performs divisional administrative duties  
  • Serves as the division’s record coordinator (RC) to ensure files for archive in accordance with agency policies
  • Serves as an administrative resource for the Division

Required Minimum Qualifications

Your application for employment must reflect how you meet each of the following minimum qualifications:
  1. Graduation from an accredited high school or attainment of a GED.
  2. Five (5) years related experience in providing technical administrative support in the insurance, medical, and/or legal environments. Technical administrative support includes but not limited to: coordination and facilitation of digital calls, using videoconferencing tools, preparing for committee/panel meetings and transcription experience.
  3. Three (3) years of advanced experience in Microsoft Word and Excel. Advanced experience should include all or any combination of functions listed below:
    1. Mail merge
    2. Comparison feature
    3. Vlook-up
    4. Working with multiple worksheets and workbooks
    5. Pivot tables
    6. Distribution techniques

Preferred Qualifications

Your application for employment should reflect how you meet the following preferred qualifications:
  1. Completion of 30 semester hours from an accredited college or university in a related discipline.

Other Information

PLEASE NOTE: All applications must contain complete job histories, which includes job title, dates of employment, name of employer, supervisor's name and phone number and a description of duties performed. If this information is not submitted, your application may be rejected because it is incomplete. Resumes do not take the place of this required information.
Other Information:  Work is temporarily performed remotely due to the COVID-19 pandemic.  When it is safe to return, work will be performed in an office environment.  This position may require access to privileged, confidential, or sensitive data.  ERS will conduct either a TXDPS or FBI criminal history check on all new hires.  For more information about this policy inquiries can be made to employment@ers.texas.gov.

Military Occupational Specialty (MOS) Codes

Veterans, Reservists or Guardsmen with experience in the Military Occupational Specialty (https://hr.sao.texas.gov/Compensation/MilitaryCrosswalk/MOSC_ProgramManagement.pdf) along with the minimum qualifications listed above may meet the minimum requirements and are highly encouraged to apply.  Please contact Human Resources at employment@ers.texas.gov  with questions or for additional information.