Supervisor, Appeals and Grievances

GLOBALHEALTH HOLDINGS LLC•Oklahoma City, OK

2d•Remote

About The Position

The Supervisor, Appeals and Grievances provides daily leadership and compliance oversight for the Appeals and Grievances (A&G) function, identifying and executing opportunities to improve timeliness and resolution in accordance with regulatory requirements. The role manages the team's workload and resources, supports employees through coaching and training, handles escalated member issues, and represents A&G concerns in department leadership meetings. The position is remote and largely sedentary, routinely using standard office equipment. Minimal travel is expected, at less than 5% in support of corporate initiatives. The supervisor manages staff and is responsible for planning, assigning, scheduling, and reviewing work; maintaining quality standards; hiring, terminating, training, developing, and reviewing staff; administering corrective action; and planning organizational structure and job content. The role also requires maintaining the confidentiality of business information, including Protected Health Information (PHI), in accordance with HIPAA and company policy. Other duties may be assigned, and duties and responsibilities may change.

Requirements

High school diploma or GED required.
At least 3 years of member services and/or customer operations experience required.
At least 2 years of appeals and grievances experience required.
At least 1 year of experience with one or more of the following required: MS Office (Power BI is a plus), call center management and reporting applications (Mitel), or CRM applications (Epic).
Exceptional prioritization and task-management skills.
Detail-oriented, able to multitask, and able to focus on multiple cases at a time.
Strong documentation skills.
Ability to perform essential job functions independently, flexibly, and using creative problem-solving techniques.
Ability to thrive in a results-oriented environment and drive tasks to completion.
Ability to maintain confidentiality of business information, including PHI, in accordance with HIPAA and company policy.

Nice To Haves

Associate degree or bachelor's degree preferred.
Familiarity with process analytics and continuous improvement methodologies such as Lean, Six Sigma, EOS, or TOC preferred.
Proven history of successful process design and implementation preferred.
Medicare and/or NCQA experience preferred.
Power BI experience is a plus.

Responsibilities

Schedule and balance available resources to match anticipated demand.
Monitor and provide oversight of the appeals and grievances process.
Handle escalations involving member issues.
Manage employee time and attendance.
Coach and train the Appeals and Grievances team.
Provide daily reporting for critical measures.
Identify and execute opportunities to improve workflows and organizational structure.
Manage daily subordinate workloads to ensure contractual and regulatory compliance.
Perform hiring, coaching, and disciplinary actions as required.
Represent and advocate for Appeals and Grievances issues and concerns in department leadership meetings.
Maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
Plan, assign, schedule, and review staff work; ensure quality standards; train, develop, and review staff performance; administer corrective action; and plan organizational structure and job content.
Perform other duties as assigned.