• Answers member calls via phone providing accurate information and assistance in a timely manner. • Assists members with customer service to resolve problems and enhance financial relationship with Mountain America. • Uses the Mountain America Credit Union AAA sales model (Assess, Advise, Assist) to cross-sell credit union products and services to members over the phone. • Maintains a thorough understanding of our credit union's products and services to effectively assess members’ needs and promote offerings. • Complies with all regulations as required by law, including but not limited to Bank Secrecy Act, OFAC, FACT Act, GLBA, Regulation CC (funds availability), Regulation DD (TIS) and other regulations as required by law as it relates to their position.

• Run live video onboarding calls with new customers to gather key business context and complete bookkeeping setup (bank/credit card connections, historical bookkeeping needs, etc.) • Support customers across chat and email by answering bookkeeping questions, diagnosing issues, and driving them to resolution quickly and empathetically • Maintain accurate customer notes and status updates in internal systems to ensure strong follow-through and smooth handoffs • Collaborate with other Layer teams to improve workflows and surface product feedback based on recurring customer needs • Exceed partner and customer expectations by providing thoughtful, proactive, and detail-oriented support

Join Us in this Amazing Opportunity The Team You’ll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Grievance Resolution Specialist Sr (Provider Resolution) and help shape the future of healthcare where you’ll be an integral part of our Grievance & Appeals team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Full Telework. - If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum. You will coordinate the overall process of complaint resolution, responding to all verbal and written complaints from members and providers relating to member eligibility and benefits, contract administration, claims processing, utilization management decisions, pharmacy and vision decisions. You will have frequent external contact with members and families, health care providers, organizations and regulators. In addition, you will frequently interact with internal contacts in Claims Administration, Customer Service, Provider Relations, Contracting, Pharmacy Management, Third-Party Administrators, Medical Management, health networks and other resources to identify the factors necessary for optimal resolution of complaints. You will be responsible for processing complex cases requiring additional research or problem-solving. You will process 1st and 2nd Level provider appeals in accordance with Department of Health Care Services (DHCS) and Centers for Medicare & Medicaid Services (CMS) guidelines and regulations. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: - 75% - Program Support - Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. - Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. - Develops and maintains adequate information systems to assure timely and effective data collection, summarization, integration and reporting, including case creation, management and events/activity tracking. - Ensures compliance with CalOptima Health’s Grievance Policy and timely case resolution, initiates and coordinates referrals to the Quality Improvement department as necessary and facilitates response to members according to policy. - Handles escalated issues from providers, as well as internal and external customers. - Gathers pertinent information regarding complaints, including member or provider concerns, claims payments, billing reimbursements, supporting information related to initial decisions, new information supporting complaints and supplemental information required to evaluate complaints and regulatory requirements. - Coordinates and participates in case discussions with operational experts to result in a final case disposition. - Reviews government claim cases and determines resolution and recommendation based on researched claims, Provider Dispute Resolution (PDR) and 2nd Level appeal analyses. - Evaluates case details related to member or provider complaints and makes appropriate decisions based on information provided and research conducted. - Provides a summary of GARS cases requested by Legal Affairs or other departments. - Provides subject matter expertise and trains new and existing staff as needed. - Assists with case assignment, assumes cases assignments per business needs and monitors the daily operations for member and provider complaints, ensuring compliance with the implementation of the decision. - Contacts appropriate parties to request and obtain missing information and supporting documentation or provides education. - Oversees resolution letters for accuracy of information and appropriate decisions. - Meets performance measurement goals for GARS. - Supports with provider appeals audits by reviewing findings, gathering and organizing requested materials and completing rebuttals. - 20% - Administrative Support - Participates in meetings regarding case assignment issues and collaborates with cross-department teams to maintain current knowledge of organizational processes and guidelines to effectively resolve cases. - Reads and interprets provider contracts, Division of Financial Responsibility (DOFR), policies, procedures and instructions. - Responds to routine provider inquiries via phone and assists with provider appeals resolution inquiries. - Tracks and trends provider appeals and claims issues. - Supports all department initiatives in improving overall efficiency. - 5% - Completes other projects and duties as assigned. Do You Have What the Role Requires? - High school diploma or equivalent PLUS 3 years of experience with Provider Non-Contracted Medicare Post-Service appeals and denials required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. - 3 years of experience with PDR in Medicare and Medi-Cal in Professional, Institutional, Outpatient, Ancillary, Coordination of Benefits and Government Cases required. - Experience with Medicare or Medi-Cal provider appeals and denials process required. - Experience in health care practice standards, for both government and commercial plans required. - Experience with claims administration required. You’ll Stand Out More If You Possess the Following: - Associate’s degree in health care administration or related field. - Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Russian, Spanish, Vietnamese). What the Regulatory Agencies Need You to Possess? - N/A Your Knowledge & Abilities to Bring to this Role: - Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. - Work independently and exercise sound judgment. - Communicate clearly and concisely, both orally and in writing. - Work a flexible schedule; available to participate in evening and weekend events. - Organize, be analytical, problem-solve and possess project management skills. - Work in a fast-paced environment and in an efficient manner. - Manage multiple projects and identify opportunities for internal and external collaboration. - Motivate and lead multi-program teams and external committees/coalitions. - Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Your Physical Requirements (With or Without Accommodations): - Ability to visually read information from computer screens, forms and other printed materials and information. - Ability to speak (enunciate) clearly in conversation and general communication. - Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. - Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. - Lifting and moving objects, patients and/or equipment 10 to 25 pounds Ways We Are Here For You - You’ll enjoy competitive compensation for this role. - Our current hiring range is: Pay Grade: 306 - $58,205 - $90,217 ($27.98 - $43.3736). - The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. - This position is approved for Full Telework (**If the position is Telework, it is eligible in California only**) - A comprehensive benefits package - CalPERS pension program and additional retirement packages. - Additional benefits and perks including: - A generous PTO program - A quality work life balance - Various wellness programs - Tuition Reimbursement - Professional development opportunities - Career development opportunities - Flexible scheduling - And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families. Our Work Environment: If located at the 500, 505 Building or a remote work location: - Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. - There are no harmful environmental conditions present for this job. - The noise level in this work environment is usually moderate. If located at PACE: - Work is typically indoors in a clinical setting serving the frail and elderly. - There may be harmful or hazardous environmental conditions present for this job. - The noise level in this work environment is usually moderate to loud. If located in the Community: - Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. - Employee will occasionally work outdoors in varied temperatures. - There may be harmful or hazardous environmental conditions present for this job. - The noise level in this work environment is usually moderate to loud. Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is April 1, 2026 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.

The SouthState story is one of steady growth, deep community roots, and an unwavering commitment to helping our customers move forward. Since our beginnings in the 1930s to becoming a trusted financial partner across the South and beyond - we are known for combining personal relationships with forward-thinking solutions. We are committed to helping our team members find their success while maintaining the integrity of our values: building trust, fostering lasting relationships and pursuing excellence. At SouthState, individual contributions are recognized, potential is cultivated and team members are inspired to achieve their greater purpose. Your future begins here! This position is remote but you must reside within 50 miles of Orangeburg SC 11:15am-8:00pm ET w/Rotating Saturday shift SUMMARY/OBJECTIVE: Provide superior customer service to external and internal customers by delivering a seamless experience to the customer regardless of the product, application, or service need. Must build and maintain rapport with the customer by quickly earning trust and establishing themselves as subject matter experts. The CCR is able to identify the customer’s problem, effectively communicate the resolution and use judgment to escalate issues and report trends to management as needed. Actively seeks to retain customer relationships. Ensures compliance with South State Bank Code of Business Conduct and Ethics and other operating procedures while still maintaining the essential customer experience. ESSENTIAL FUNCTIONS - Identify and resolve customer inquiries using active listening, critical thinking, and probing skills for first call resolution. - Answers inbound phone inquiries timely, accurately, and professionally with a personalized rewarding experience for the customer. - Able to successfully respond to general inquiries regarding accounts to include but not limited to balance inquiries, transaction history, transfers, stop payments, loan inquiries, phone banking PIN resets, customer maintenance updates, product assistance and check orders. Provide tier one digital banking support to include Multi-Factor Authentication unlock or delete, unlock customer’s Online Banking profile, and assist customer with self-service password tool. Assist customers with debit card support to include inquiries, research, blocking, reissuing/reordering cards, and Reg-E disputes. - Process customers inquiries accurately and efficiently to build customer confidence and trust, based on established policies and procedures. - Promote our virtual branch solutions to our customers by ensuring we met or exceeded their expectations. - Meet or exceed the Customer Care Representative quality and productivity goals assigned by management. - Ensure the security of customer information and assist with minimizing bank loss by performing customer authentication on each call received. - Use all available systems and resources to review and interpret customer information - Maintain a working knowledge of PC skills including the ability to troubleshoot common problems and navigate the internet, intranet and between multiple systems. - Provide support by performing additional duties and tasks as needed or assigned. - Maintain a positive, empathetic, and professional demeanor with customers at all times regardless of the circumstances, or stress level of the call center. - Keep customers aware of changes in bank services, practices and other factors affecting their account relationship. - Follow established processes and guidelines in daily activities to do what is right for the customer and the bank, adhering to all company and department policies. - Successfully complete additional skills training as required/requested. COMPETENCIES - Strong knowledge of banking procedures. - Patience, ability to remain calm even when the customers are stressed or upset. - Strong multi-tasking and problem-solving skills to handle and respond to inquiries timely. - Attentiveness, ability to listen to customers concerns, identify the issues and find a resolution. Accepts other duties as assigned. The duties and responsibilities listed above may be revised at any time within the sole discretion of SouthState without advance notice to or the consent of the employee. SouthState reserves the exclusive right to transfer an employee, without their consent or advance notice, from their current position to any other position within the same branch or a different branch. Qualifications, Education, and Certification Requirements: Must reside within 50 miles of Orangeburg, SC - Education: High School Diploma or equivalent - Experience: Previous customer service (Inbound Call Center) experience, Experience in financial services, Strong computer skills and ability to navigate systems for quick resolution - Certifications/Specific Knowledge: Must have excellent customer service skills including verbal, listening, and problem-solving skills. Must be enthusiastic and highly motivated with a strong work ethic and intense focus on results. Ability to work with confidential information, both internally and externally, in a professional manner. Ability to have flexible hours when necessary. Receptive to coaching and feedback. Demonstrate the desire to meet/exceed goals and solve problems while working in a fast-paced environment. Interpersonal skills to create a positive and effective work environment. TRAINING REQUIREMENTS/CLASSES - Annual Regulatory Compliance Training - Successfully complete Customer Care New Hire Training PHYSICAL DEMANDS/WORK ENVIRONMENT - Must be able to effectively access and interpret information on computer screens, documents, reports, and identify customers. - This position requires a large amount of time in front of a computer. - SouthState reserves the right to modify its Remote Work Standards and Eligibility requirements at any time. - SouthState reserves the right to suspend Remote Work privileges at any time. TELECOMMUTING REQUIREMENTS - Required to have a dedicated work area established that is separated from other living areas and provides information privacy. - Ability to keep all company sensitive documents secure (if applicable) - You agree that you will not provide child or adult care during hours of scheduled work. TELECOMMUTING TECHNICAL REQUIREMENTS - A minimum of 10 mbps download and 5 mbps upload speed from a reliable internet provider (Cable, DSL or Fiber Optic/FiOS providers only). - Must be able to directly connect to router/modem via Ethernet cable. Check your download speed using a speed test. - To test your home internet from your personal computer at home, type www.speedtest.net into the web browser of your personal computer. - SouthState reserves the right to request proof of internet provider, speed and service package from the employee. - Requirements are subject to change, as new systems and technology are delivered. TRAVEL Must be available to travel when necessary. Must reside within 50 miles of Orangeburg, SC Equal Opportunity Employer, including disabled/veterans.