Troy, MI, United States
Nov 14, 2021
Supervisor, Grievances & Appeals - Remote, EST or CST
The Supervisor, Grievances & Appeals manages client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. The Supervisor, Grievances & Appeals works within thorough, prescribed guidelines and procedures; uses independent judgment requiring analysis of variable factors to solve basic problems; collaborates with management and top professionals/specialists in selection of methods, techniques, and analytical approach.
The core hours are Mon-Fri, with occasional weekend support.
The Supervisor, Grievances & Appeals assists team members who are providing support to members/providers focused on resolution to grievances and appeals. Investigates and resolves member and practitioner issues.
Decisions are typically are related to schedule, plans and daily operations. Performs escalated or more complex work of a similar nature, and supervises a group of typically support and technical associates; coordinates and provides day-to-day oversight to associates. Ensures consistency in execution across team. Holds team members accountable for following established policies.
4 - 6 years of customer service experience in the healthcare industry or medical field
Minimum of 1 year experience as Team Lead or Supervisor, in the healthcare industry or medical field, to include coaching and developing associates formally and informally
Experience working in a high volume production environment
Excellent written, verbal and electronic communication skills
Advanced proficiency in Microsoft Office programs including Word, Excel, and Outlook
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
We will require full COVID vaccination (**** for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates and the communities we serve.
If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law. Requests for these exemptions should be submitted at least 2 week prior to your scheduled first day of work.
Previous experience working in Grievance and Appeals -
Beginner knowledge in Microsoft PowerPoint and Access
General understanding of healthcare economic, financial and operational concepts
Results oriented; problem solver
Bilingual English/Spanish - must be able to speak, read and write in both languages without limitations or assistance
Work at Home/Remote Requirements
Must ensure designated work area is free from distractions during work hours and virtual meetings
Must provide a high-speed DSL or cable modem for a workspace (Satellite, wireless and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required
Scheduled Weekly Hours