Manager, Customer Care – Medicare Strategy

This is a fully remote position, open to applicants in Ohio.

📋 Description

• Provide guidance and direction to team members to ensure departmental objectives and standards are met.

• Supervise staff to guarantee the timely and accurate completion of tasks and resolution of issues.

• Oversee and monitor processes to ensure compliance with regulatory requirements and accreditation standards.

• Ensure grievances and appeals are managed and reported appropriately.

• Analyze grievance and appeal submissions and provide constructive feedback to relevant business areas.

• Design, implement, and deliver training for grievances and appeals.

• Assess operations to identify opportunities for process enhancements.

• Recognize irregular trends, investigate root causes, and assist in resolution strategies.

• Track trends and changes in regulations to determine their impact on the department.

• Report relevant data to the appropriate CareSource committees.

• Oversee, develop, and implement grievances and appeals processes for new product lines.

• Review and interpret regulatory requirements to ensure adherence to policies and processes.

• Lead initiatives to monitor and analyze grievances and appeals data to facilitate process improvements.

• Foster team accountability and adaptability in alignment with the organization's mission and vision.

• Perform other duties as assigned.

⛳️ Requirements

• A Bachelor’s degree or equivalent relevant work experience is required.

• Prior experience in the healthcare sector is preferred.

• A minimum of three (3) years of management experience is preferred.

• A minimum of four (4) years of experience in grievances and appeals is preferred.

• Proficient in Microsoft Office Suite, including Word, Excel, and PowerPoint.

• Basic familiarity with ACD systems.

• Basic knowledge of Call Management Systems.

• Excellent written and verbal communication abilities.

• Strong interpersonal skills, a high level of professionalism, and a collaborative management approach.

• Effective problem-solving skills with meticulous attention to detail.

• Strong listening and critical thinking capabilities.

• Ability to work independently and collaboratively within a team environment.

• Capability to develop, prioritize, and achieve goals.

• Strategic management skills are essential.

• Familiarity with the healthcare field, particularly knowledge of Medicaid and Medicare.

• Capacity to thrive in a fast-paced and ever-changing environment.

• No specific licensure or certification is required.

🏝️ Benefits

• Potential bonus linked to both company and individual performance.

• Comprehensive and substantial total rewards package.

• Support for employee total well-being.