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Healthcare Appeals and Grievances Manager
2 months ago
The Appeals and Grievances Supervisor is a critical role within the Customer Solution Center, responsible for leading a team that handles appeals and grievances in a healthcare setting. This position requires strong leadership and analytical skills, with the ability to manage large volumes of data and navigate complex regulatory requirements.
Key Responsibilities- Supervise and support a team of professionals in handling appeals and grievances, ensuring thorough investigations and timely resolutions.
- Develop and maintain policies and procedures, workflows, and training programs to ensure compliance with regulatory entities and company standards.
- Collaborate with internal departments to ensure effective communication and timely resolution of appeals and grievances.
- Analyze and trend appeals and grievances to identify areas for improvement and develop strategies for resolution.
- Provide coaching, training, and development opportunities to team members to enhance their skills and performance.
- At least 3 years of experience in a healthcare setting in grievances and appeals, compliance, claims, or call center.
- At least 2 years of supervisory or management experience, with a proven track record of leading teams and driving results.
- Strong analytical and problem-solving skills, with the ability to manage large volumes of data and navigate complex regulatory requirements.
- Excellent communication and interpersonal skills, with the ability to collaborate with internal departments and external stakeholders.
- Computer ease and literacy with Microsoft Office, with experience in data analysis and reporting.
Insight Global offers a comprehensive benefits package, including medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.
