Supervisor, Appeals

DescriptionPOSITION SUMMARY The Supervisor will lead the Appeal team, who review member and provider appeals involving plan benefit disputes, attorney complaints, and department of insurance complaints for various blocks of business. Responsible for the daily administration of the Appeals department to ensure the resolutions are legal and follow plan policies and procedures. Monitor the research, investigation, and resolution of adverse benefit determinations. Provide guidance and direction to team members. The Supervisor will also be responsible for staff management, which includes hiring, training, development, coaching, as well as mid-year and annual reviews. Essential Functions

• Communicate status updates, issues, and recommendations to management.
• Compose letters for escalated and priority appeals
• Review high dollar appeal determinations with General Counsel.
• Assign work to team members.
• Track workload and inventory.
• Monitor turn-around times.
• Ability to trouble shoot issues as needed.
• Provide training to team members.
• Oversee new business and renewal process and delegate work as needed.
• Ensure each team member is cross trained.
• Serve as point of contact to other departments for escalated issues.
• Establish and maintain efficient workflows and quality measures.
• Lead, coach, motivate and develop. Responsible for one-on-one meetings, performance appraisals, growth opportunities and attracting new talent.
• Clearly communicate expectations, provide employees with the training, resources, and information needed to succeed.
• Actively engage, coach, counsel and provide timely, and constructive performance feedback.
• Other tasks and projects as assigned.

EDUCATION

• Bachelor's degree or equivalent work experience required.

Experience & Skills

• Must have at least 3 years of experience in health insurance, appeals investigation and processing required.
• Must demonstrate leadership potential
• Must have strong analytical skills and knowledge of computer systems and CPT and ICD-9 coding terminology.
• Demonstrate the ability to supervise tasks and contribute to the Team atmosphere and concept.
• Exceptional writing skills, with the ability to produce clear and concise correspondence.
• Attention to detail and excellent organizational skills.
• Prior experience in management and training

COMPETENCIES

• Accountability
• Communication
• Action Oriented
• Timely Decision Making
• Building Relationships/Shaping Culture
• Customer Focus

PHYSICAL DEMANDS

• This is a standard desk role – long periods of sitting and working on a computer are .

WORK ENVIRONMENT

• Remote