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Appeals & Grievances Supervisor
2 months ago
One of our top clients in Downtown Los Angeles is looking for an Appeals & Grievances Supervisor to join their team mostly remote (on-site 2 days/month expected)
Required Skills and Experience:
- 3+ years’ experience in a healthcare setting in Grievances and Appeals, Compliance, Claims or Call Center.
- 2+ years’ experience leading process, program, or staff or supervisory experience.
- Ability to manage and organize large volumes of data.
- Knowledge of regulatory and accreditation entities and their requirements.
- Good working knowledge of licensure and regulatory requirements, and accreditation standards.
- Computer ease and literacy with Microsoft Office (Word, Excel, Power Point, Access, and Visio).
Responsibilities include:
- The Supervisor of the Customer Solution Center Appeals and Grievances is responsible for directly supervising and supporting the team that handles the intake, research, resolution, tracking, trending, and reporting within the Appeals and Grievances department.
- This role involves leading and directing the team’s work by monitoring the research, negotiation, and resolution of all types of appeals and grievances, ensuring thorough investigations are completed according to company policies and procedures.
- The supervisor provides support and takes ownership of cases identified as escalated, complex, and/or multi-issue appeals and grievances as needed.
- Collaboration with internal departments is essential to ensure timely resolution.
- Additionally, this position is responsible for analyzing and trending all appeals and grievances, developing and maintaining the appeal and grievance policies and procedures, workflows, member correspondence, and training as needed or on an annual basis.
- The supervisor oversees all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.
- This position requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical situations and work on-call.
- This position requires handling various caseloads and flexibility to adapt to changing priorities which may include but not limited to redistributed work assignments, team projects, and other priorities as assigned.
