Supervisor, Grievance & Appeals

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

📋 Description

• Oversee the daily operations of the Appeals and Grievance team and their activities

• Ensure that productivity and quality standards are achieved

• Assist the team with escalated or intricate issues

• Manage and allocate the case load effectively

• Ensure that appeals, grievances, and complaints are addressed in accordance with established standards and corporate policies

• Act as a resource for escalated or complex matters, process and systems challenges, and updates on regulations

• Supervise and distribute the team's case load while ensuring sufficient coverage

• Assess performance standards and provide daily feedback and guidance for resolving issues

• Identify and create opportunities for process improvements, collaborating with various departments to prevent future occurrences

• Train and onboard new staff members

• Carry out additional responsibilities as required

• Adhere to all policies and standards

⛳️ Requirements

• Bachelor’s degree in a relevant field or equivalent experience

• Preferred: 2+ years of experience in processing appeals and grievances within a healthcare or managed care environment

• Preferred: Knowledge of healthcare law

• Must be available to work rotational weekends and holidays to meet turnaround requirements

• Must adhere to core business hours, Monday to Friday, 8am to 5pm

• Experience in supervising Appeals and Grievance teams and their operations

• Understanding of appeals, grievances, complaints, and the processes, policies, and regulatory requirements related to healthcare or managed care

🏝️ Benefits

• Competitive compensation

• Health insurance coverage

• 401K and stock purchase options

• Tuition reimbursement assistance

• Paid time off along with holidays

• Flexibility in work arrangements, including remote, hybrid, field, or office schedules

• Eligibility for bonuses