Supervisor, Appeals Grievance (State)

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. reputed company is a reputed company, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Remote-CA. *

Must reputed company in California

* reputed company reputed company experience with claims, appeals, and grievance strongly preferred. Position Purpose: The Supervisor of Appeals & Grievances is accountable for the recruitment, hiring, promotion, counseling, and daily supervision of Grievance and Appeals Specialists and administrative support as they receive, investigate and resolve member complaints, member grievances, and provider disputes. This position is also responsible for the coordination of the resolution of grievance situations requiring competent and effective resolution in compliance with legal and regulatory requirements. This position will also reputed company initial and ongoing training in necessary skills and knowledge reputed company and will assist Manager of Grievance and Appeals to establish and maintain procedures for Unit to maximize both outcomes and operational efficiency. Provides daily supervision for Grievance and Appeals Unit, including coordination of backup staffing, cross-training and deployment. Performs reputed company, hiring, promotion, and performance evaluation tasks and counsels non-clinical Grievance and Appeals staff. Orients and trains new Grievance and Appeals Unit members. Continually trains Unit members concerning grievances, appeals, and provider disputes/appeals. Regularly audits work of G&A Specialists and reports results. Coordinates investigation and resolution of reputed company appeal and grievance issues. Provides approval reputed company involving grievance and appeal determinations. Coordinates maintenance and updates of desktop procedures and manuals for Unit. Assists in the establishment of grievance operating procedures. Prepares reports as required and performs trend analyses. Participates in Health Plan audits as needed. Performs other reputed company duties as required. Performs other duties as assigned Complies with reputed company policies and standards Education/Experience: High School Diploma. Bachelor’s Degree preferred. 5+ years of experience in Managed Care. 2+ supervisory experience preferred. Pay Range: $26.50 - $47.59 per hour reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law. Total compensation may also include additional forms of incentives. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act Thanks for your interest in reputed company and its subsidiary companies. We’re so glad that you’ve decided to fill out an application and take the reputed company to find your purpose. Also, we’re here to help support you on your candidate journey. Should you need an accommodation, please email reputed company@reputed company.com. reputed company is committed to helping people live healthier lives. We provide access to high-quality reputed company, innovative programs and a wide range of health solutions that help families and individuals reputed company, stay well and be well. Apply Job!