Supervisor, Appeals Grievance

About This Role

Supervise a Grievance and Appeals Unit, overseeing the recruitment, training, and daily operations of specialists. Ensure timely and compliant resolution of member complaints, grievances, and provider disputes, adhering to legal and regulatory requirements.

Responsibilities

• Provide daily supervision for the Grievance and Appeals Unit, including coordination of backup staffing, cross-training, and deployment.
• Perform recruiting, hiring, promotion, and performance evaluation tasks, and counsel non-clinical Grievance and Appeals staff.
• Orient and train new Grievance and Appeals Unit members.
• Continually train Unit members concerning grievances, appeals, and provider disputes/appeals.
• Regularly audit work of G&A Specialists and report results.
• Coordinate investigation and resolution of complex appeal and grievance issues.
• Provide approval decisions involving grievance and appeal determinations.
• Coordinate maintenance and updates of desktop procedures and manuals for the Unit.
• Assist in the establishment of grievance operating procedures.
• Prepare required reports and perform trend analyses.
• Participate in Health Plan audits as needed.

Requirements

• 5+ years of experience in Managed Care
• Proven leadership experience
• Reside in California

Qualifications

• High School Diploma. Bachelor’s Degree preferred.
• 5+ years of experience in Managed Care. 2+ supervisory experience preferred.

Nice to Have

• Bachelor's Degree
• 2+ years of supervisory experience
• Background in call center training, auditing, quality assurance, and grievance and appeals

Benefits