Grievance Compliance Advisor

Execute audit procedures for Customer Solution Center departments, ensuring readiness for regulatory audits by identifying issues, developing criteria, and reviewing evidence. Lead audit situations involving member interactions and outcomes, presenting full findings to management and verifying action plans for remediation. Evaluate policies and procedures against guidelines from DHCS, CMS, and NCQA to recommend continuous process improvements. Collaborate with business units to validate audit universe preparation and document business unit processes. Maintain compliance program efforts through training initiatives and policy development.