If the Eligibility Specialist receives a complaint from the claimant or his/her representative, the Eligibility Specialist must:
- Review the complaint promptly and:
- If the Eligibility Specialist can resolve the complaint, they should do so and record an EUMEMROL comment in FAMIS as to the issue and action taken, and discuss with immediate Supervisor.
- If the Eligibility Specialist is unable to resolve issue, advise the individual that the complaint will be reviewed by the Eligibility Specialist Supervisor; and
- Schedule a time for the Eligibility Specialist Supervisor to contact the complainant regarding follow-up.
- Forward this information as well as case record to the immediate supervisor, prior to scheduled conference with the complainant.
- Understand that the customer has the opportunity to discuss their complaint with the Eligibility Specialist Supervisor at any time.
The immediate supervisor will:
- Review the case record regarding the complaint issues; and
- Prepare for and schedule a conference with the Eligibility Specialist.
The Eligibility Specialist and the supervisor jointly decide upon the action to be taken.
The Eligibility Specialist will complete any necessary follow-up action, i.e.:
- Notification of the individual of findings;
- Record a complete, clear, and concise comment on EUMEMROL of the action(s) taken and resolution(s) reached; and
- Submit the completed record to the immediate supervisor, for sign-off.