Supervisor, Grievance & Appeals
Core
Supervise the day-to-day operations of the Appeals and Grievance staff and functions, ensuring productivity and quality metrics are met for retrospective appeals processes.
Role type
Team lead / Supervisor for appeals and grievances processing
Builds
Retrospective appeals processes for AIP/duals members
Domain
Healthcare / Managed care
Required skills
Team supervision, case load distribution, performance evaluation, process improvement, training and onboarding, regulatory compliance
Preferred skills
Healthcare or managed care appeals processing experience, healthcare law knowledge
Responsibilities
Ensure department processes appeals, grievances, and complaints in accordance with standards; Serve as a resource for escalated or complex issues; Monitor and distribute team's case load; Monitor and evaluate performance standards; Identify and develop opportunities for process improvements; Train and onboard new team members