Medicaid Appeals & Grievance Associate Manager - Must live in Louisiana
Core
Manage staff and handle member/provider appeals, complaints, and grievances for health insurance products, ensuring compliance with federal and state regulations.
Role type
Associate Manager, Appeals & Grievance
Builds
Timely resolution of insurance appeals and grievances
Domain
Health Insurance / Risk Management
Deliverable
Dashboards & analysis
Required skills
Benefit language interpretation, Project management, Workflow documentation, Regulatory compliance analysis, Team leadership, Performance management
Preferred skills
Claim platform experience, Patient management, Contract drafting, Compliance analysis, Provider relations, Audit experience
Technologies
Claim platforms
Responsibilities
Coordinate resolution of appeals and grievances; manage team productivity and resources; mentor staff on policies and procedures; identify trends and recommend solutions; handle incoming case loads and research claim logic; ensure adherence to quality measures and turnaround times.
Seniority
Manager, hands-on IC