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Supervisor, Appeals

Company: GEHA, Inc.
Location: Independence
Posted on: November 22, 2021

Job Description:

Summary Assigns, administers and evaluates the work of Appeals & Grievances employees. Analyzes department production reports and quality results to maintain adequate staffing. Coordinates the responses of inquiries from member, providers and the Office of Personnel Management (OPM). Maintains records of all activity pertaining to disputed claims. Analyzes disputed claims trends and appeals. Notifies senior management of identified patterns or trends. Duties -- Coordinates, supervises and is accountable for the daily/weekly/monthly activities of the Appeals & Grievances team. -- Sets priorities for the team to ensure task completion and performance goals are met, such as quality, turnaround time, and other service levels. -- Provides regular coaching and feedback to team members, including formal corrective action. -- Conducts annual and bi-annual performance reviews for team members. -- Participates in the hiring process for the team. -- Provides expertise and customer service support to members, providers and OPM. -- Provides expertise and/or general instruction to support teams in reviewing, researching and processing of claim appeals. -- Collaborates with Care Management and Claims leadership to ensure procedures and responses are consistent with Contractual benefits, established policies and procedures. -- Conducts monthly performance sessions with individual subordinates to review performance against established standards. -- Coach employees for optimal performance development. Identifies individual and department training needs. May assist with re-training of department employees. -- Recommends updates and creation of department policies and procedures. Reviews updates with staff to ensure understanding. -- Accountable for work group objectives where goals and processes are defined. Job Requirements:Education Requirements Requires a Bachelor's Degree. Additional years of qualifying work experience may be considered in lieu of formal education. -- Experience Requirements ------------------ Requires three years health plan or health care--experience that includes qualifying supervisory experience. ------------------ Requires thorough knowledge of area that will be managed so can direct on items outside documented guidelines. ------------------ Requires effective verbal and written communication skills. ------------------ Organizational skills are necessary to respond to inquiries, set schedules, meet project deadlines and instruct employees. ------------------ Incumbent is required to obtain knowledge of GEHA---s Affirmative Action policy and make decisions regarding employment, promotion and termination of employees that comply with its principles. -- Preferred Appeals experience -- -- GEHA is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. We celebrate diversity and are committed to creating an inclusive environment for all employees. -- As a condition of employment, all GEHA employees must be fully vaccinated against COVID-19 unless a medical or religious exemption is approved. --

Keywords: GEHA, Inc., Independence , Supervisor, Appeals, Other , Independence, Missouri

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