Supervisor of Appeals & Grievances

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

The Supervisor will provide daily oversight and monitoring of staff intaking and assigning all appeals and grievances for all product lines and ensuring compliance with internal policies/process state and federal regulatory requirements. Responsible for overseeing and monitoring appeals and grievances received through delegated vendors, including auding the delegated vendors processes to ensure regulatory compliance. Maintains and ensures integrity of case file, documentation accuracy, and data collection systems, and prepares data reports and analysis of grievance and appeals for program management and committees, as needed. Maintains current knowledge of state/federal regulatory requirements for each program. Identifies and recommends areas for staff education and develops and implements training programs. Works under general direction.

• BA/BS degree in Health/Human Services, Health Administration, Business Administration or related discipline is required. An associates degree will be considered with prior experience.
• 4-5 years prior related experience is required, preferably in Managed Care or Health Care related organizations.
• Minimum 1-3 years expereince with appeals and grievances.
• Computer literacy including Microsoft Word, Excel, Powerpoint, capacity to learn other programs as assigned.
• Excellent written and oral communication skills.
• Good analytical abilities.
• Ability to be empathetic and understanding.
• Ability to handle confidential aspects of the position.
• Good customer service skills.
• Ability to set priorities.
• Ability to work independently while recognizing issues having a departmental or organizational impact.

Required

Preferred

Job Industries

• Other