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Customer Solution Center Supervisor
2 months ago
The Appeals and Grievances Supervisor is a key member of the Customer Solution Center team, responsible for overseeing the intake, research, resolution, tracking, trending, and reporting of appeals and grievances within the 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 and Communication**
- Collaborate with internal departments to ensure timely resolution of appeals and grievances.
- Develop and maintain effective relationships with stakeholders to drive business outcomes.
**Analytical and Problem-Solving Skills**
- Analyze and trend all appeals and grievances to identify areas for improvement.
- Develop and implement strategies to resolve complex and escalated cases.
**Leadership and Management**
- Oversee all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.
- Develop and implement training programs to enhance team performance and knowledge.
**Requirements**
- At least 3 years of experience 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.
- Ability to manage and organize large volumes of data.
- Knowledge of regulatory and accreditation entities and their requirements.
- Computer ease and literacy with Microsoft Office (Word, Excel, PowerPoint, Access, and Visio).
- Equivalency: Completion of the L. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.
**Work Environment**
- 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.
