Supervisor, Grievance & Appeals
About The Position
The Supervisor, Grievance & Appeals supervises the day-to-day operations of Appeals and Grievance staff and functions, ensuring productivity and quality metrics are met. The supervisor supports the team with escalated or complex issues and monitors and distributes its workload. This remote, work-from-home role supports AIP/duals members in Delaware, Michigan, Ohio, Texas, Illinois, and South Carolina with the retrospective appeals process. Core business hours are Monday through Friday, 8 a.m. to 5 p.m., with rotational weekend and holiday work required to meet turnaround time frames. The position is bonus eligible.
Requirements
- Bachelor’s degree in a related field or equivalent experience.
Nice To Haves
- At least 2 years of appeals and grievances processing experience in a healthcare or managed care setting.
- Experience in healthcare law.
Responsibilities
- Ensure the Appeals & Grievance department processes appeals, grievances, and complaints in accordance with standards and corporate policies and procedures.
- Serve as a resource for escalated or complex issues, process and systems issues, and regulatory updates.
- Monitor and distribute the team’s caseload and ensure adequate coverage.
- Monitor and evaluate performance standards and provide daily feedback and guidance on problem resolution.
- Identify and develop process improvement opportunities and work with other departments to correct problems and prevent recurrence.
- Train and onboard new team members.
- Perform other duties as assigned.
- Comply with all policies and standards.
Benefits
- Competitive pay
- Health insurance
- 401(k)
- Stock purchase plans
- Tuition reimbursement
- Paid time off and holidays
- Flexible approach to work, with remote, hybrid, field, or office work schedules
- Bonus eligibility
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What This Job Offers
Job Type
Full-time
Career Level
Manager
