Appeals and Grievances Supervisor
1 month ago
The Appeals and Grievances Supervisor is responsible for direct supervision and support of the team responsible for the intake, research, resolution, tracking, trending and reporting within the Appeals and Grievances department. This position will be accountable for leading and directing the work for the Appeals and Grievances department by monitoring the research, negotiation and resolution of all types of appeals and grievances to ensure thorough investigations are completed as outlined in the company policies and procedures. Provides support and ownership of cases identified as escalated, complex and/or multi-issue appeals and grievances on an as needed basis. Collaborates with internal departments to ensure timely resolution. This position will be responsible for analyzing and trending for all appeals and grievances. Responsible for the development and maintenance of the appeal and grievance Policies and Procedures, workflows, Member correspondence, and training as needed, or on an annual basis. The position supervises all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.
Duties:
- Evaluate daily reports to ensure individual and team Key Performance Indicators (KPIs), SLAs, Performance Scorecards meet regulatory requirements.
- Provide direction to staff for complex/sensitive member and provider inquiries, concerns, complaints, appeals, and grievances. Conduct weekly 1:1s with direct reports.
- Build and maintain strong working relationships with internal departments involved in appeal and grievance resolution.
- Development, maintenance and implementation of P&Ps, workflow and training.
- Audit preparation and providing recommendations for Corrective Action Plans from state regulatory agencies.
- Supervise staff , including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.
Must-Have Requirements:
- At least 3 years in a healthcare setting in Grievances and Appeals, Compliance, Claims or Call Center.
- At least 2 years of leading process, program, or staff or supervisory experience.
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Los Angeles, United States L.A. Care Health Plan Full timeCustomer Solution Center Appeals and Grievances Specialist II (ALD) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 11362 Salary Range: $60,778.00 (Min.) - $75,950.00 (Mid.) - $91,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public...
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Los Angeles, United States L.A. Care Health Plan Full timePress Tab to Move to Skip to Content Link Select how often (in days) to receive an alert: Select how often (in days) to receive an alert: Customer Solution Center Appeals and Grievances Specialist II (ALD) Job Category: Customer Service Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 11362 Salary Range: $60,778.00 (Min.) -...
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Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $60,778.00 (Min.) - $75,950.00 (Mid.) - $91,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million...
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Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $60, Min.) - $75, Mid.) - $91, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members, we make sure our members get...
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Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $60,778.00 (Min.) - $75,950.00 (Mid.) - $91,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million...
