Job Description Summary:
The Appeals Supervisor will oversee a team of Appeals Specialists and Pre-Conference Hearings Specialists. The successful Supervisor will have experience analyzing reports (operations, quality, performance, etc.) and using them to identify opportunities to improve contract performance through identifying anomalies in performance. After identifying opportunities for improvement, you’ll direct the efforts of the team to fix those performance issues (primarily within the Appeals and Eligibility spaces).
Job Summary:
Essential Duties and Responsibilities:
Minimum Requirements:
- Oversee functions associated with healthcare applications processing, complaints, and appeals.
- Assist management with department/project objectives.
- Provide supervision to assigned staff.
- Responsible for reporting issues, problems and concerns to management.
- Complete daily and weekly reports.
- Participate in the training of new staff.
- Compile and analyze daily production statistics.
- Monitor workload and coordinate schedules with Work Force Management.
- Responsible for coaching team, setting expectations, conducting performance appraisals, providing career development, corrective action and recognition for assigned staff.
- Monitor team performance to ensure team/project meets Service Level Agreements.
- Provide staff performance feedback and mentoring to continuously meet and exceed individual goals.
- Evaluate the need for training to ensure specialists maintain current knowledge of multiple programs.
- Provide the Manager with updates on all issues regarding quality, training, policy, procedures, personnel, and departmental performance levels.
Minimum Requirements:
- Associate degree or equivalent combination of education, technical training or work experience considered in lieu of degree.
- Minimum of two (2) years of related experience.
- Ensure compliance with company Wage & Hour policy, including ensuring non-exempt employees get the rest & meal breaks.
- Comply with all company required policies, procedures and processes including but not limited to required training.
- Provides immediate supervision to a unit or group of employees, assigning tasks, checking work at frequent intervals, and maintaining schedules.
- A portion of time is normally spent performing individual tasks related to the unit or sub-unit.
- Generally supervises semi-skilled employees or a few individual professional contributors.
- Works on issues of limited scope.
- Follows established practices and procedures in analyzing situations or data from which answers can be readily obtained.
- Monitors daily operations of a unit or sub-unit. Requires full knowledge of own area of functional responsibility.
- Frequently interacts with subordinate employees and functional peer groups.
- Interaction normally requires the ability to gain cooperation of others, conducting presentations concerning specific projects or schedules.
- Receives predetermined work assignments that are subject to a moderate level of control and review.
- Directs subordinates to complete assignments using established guidelines, procedures and policies.
- Develop work schedules and assign duties to subordinates to ensure efficiency.
- Evaluate subordinates' job performance and recommend appropriate personnel action.
- Discuss job performance concerns with subordinates to identify causes and issues and works closely with the Human Resources department on resolving problems.
- Identify training needs and development opportunities for subordinates.
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