Supervisor, Appeals

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

📋 Description

• Oversee the processing and evaluation of appeals, disputes, and reconsiderations.

• Escalate the most intricate issues in alignment with state and NCQA regulations.

• Manage daily operations and guide the team to ensure prompt processing.

• Monitor and document issues to guarantee accurate processing and resolution.

• Offer expert advice for resolving issues and processing tasks.

• Ensure the team's adherence to contract stipulations, policies, procedures, and performance benchmarks.

• Identify areas for process and quality enhancements.

• Assess team performance and provide constructive feedback on achievements, goals, and career progression.

• Coach and mentor the team to secure timely resolutions.

• Assist with onboarding, recruiting, and training new team members.

• Lead and advocate for change within designated responsibilities.

• Perform additional tasks as required.

⛳️ Requirements

• Bachelor’s degree and a minimum of 4 years of relevant experience, or comparable experience gained through applicable knowledge, duties, scope, and skills.

• Background in managed care, appeals, and claims processing.

• Experience in people leadership.

• Familiarity with state and National Committee for Quality Assurance (NCQA) standards.

• Understanding of contract stipulations, policies, procedures, and performance expectations.

• Availability to work during Central Time Zone hours.

• Commitment to adhering to all policies and standards.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement assistance.

• Paid time off in addition to holidays.

• Flexible work arrangements, including remote, hybrid, field, or office schedules.

• Potential for additional incentives as part of total compensation.

• Equal opportunity employer dedicated to fostering diversity.