Skills & Competencies for Appeal Resolution Senior Manager

Appeal Resolution Senior Manager job profile

JOB SUMMARY for Appeal Resolution Senior Manager

Directs the overall grievance and appeal process operations that encompass the review, investigation, negotiation and processing of disputed medical, insurance, and other claims.

JOB RESPONSIBILITIES for Appeal Resolution Senior Manager

Ensures that work activities are compliant with all regulatory guidelines and policy protocols. Allocates resources to ensure an effective and efficient case workload that achieves operational objectives. Provides expert subject matter guidance and may represent the organization at hearings.

Appeal Resolution Senior Manager SALARY RANGE

BASE 50%
$141,558
TOTAL 50%
$165,104
Job Level
M03
Job Code
HC07000707
Education/Degree
Bachelor's Degree
Reports To
Senior Manager or Head of a Unit/Department

Appeal Resolution Senior Manager Skills and Competencies List

Proficiency Levels and Behavioural Indicators
Salary.com identifies five increasing levels of proficiency for each skill/competency. Some jobs require only a relatively low level of proficiency in each skill/competency, while other jobs will require a more advanced level of proficiency in the same skill/competency. These levels rate the degree of proficiency (skill level, expertise) we expect the incumbent to perform in the given skill/competency for the given job. Note that we intentionally do not associate timeframes or years of experience in performing the skill/competency because that can be misleading. Proficiency levels identify what the incumbent knows and can do rather than how long they have been doing it. Also, note that the proficiency levels are cumulative, e.g., a level 4 proficiency implies the ability to perform all the behaviors at the lower levels.
Check each Appeal Resolution Senior Manager skill and competencie below to view definitions.

8 general skills or competencies (Job family competencies) for Appeal Resolution Senior Manager

1 Job Family Competencies – Document Management
Proficiency Level -3
Skill definition-Capturing, tracking, storing, and retrieving digital information to organize files, improve accuracy, and provide easy access to documents.
Level 1 Behaviors
(General Familiarity)
Lists commonly used software in document management for accurate record tracking and storage.
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Level 2 Behaviors
(Light Experience)
Supports the configuration of document management systems for a centralized repository.
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Level 3 Behaviors
(Moderate Experience)
Uses the document management system database to maximize document storage and review functions.
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Level 4 Behaviors
(Extensive Experience)
Recommends solutions to resolve document risks to prevent document losses and misfiling.
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Level 5 Behaviors
(Mastery)
Mentors relevant teams responsible for electronic and physical documents to drive efficiency in document management.
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2 Job Family Competencies – Contract Compliance
Proficiency Level -3
Skill definition-Ability to comply with regulations and performance of obligations within the agreement.
Level 1 Behaviors
(General Familiarity)
Lists all the procedures used in verifying compliance with contract requirements.
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Level 2 Behaviors
(Light Experience)
Supports the development of contract compliance within your organization.
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Level 3 Behaviors
(Moderate Experience)
Reviews important contract language to identify financial and legal impacts.
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Level 4 Behaviors
(Extensive Experience)
Oversees the contract negotiations between both parties to ensure safety and regulatory compliance.
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Level 5 Behaviors
(Mastery)
Keeps up to date with all compliance policies to ensure alignment with contract agreements.
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3 Appeal Resolution Senior Manager - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Appeal Resolution Senior Manager
Proficiency Level - 4
5 Competency for - Appeal Resolution Senior Manager
Proficiency Level - 5

13 soft skills or competencies (core competencies) for Appeal Resolution Senior Manager

1 Core Competencies – Industry Knowledge
Proficiency Level -2
Skill definition-Demonstrating thorough knowledge of the industry's value chain, business, issues, trends, etc., and the ability to apply them appropriately.
Level 1 Behaviors
(General Familiarity)
Names the primary regulatory agencies of the industry.
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Level 2 Behaviors
(Light Experience)
Incorporates industry knowledge and product expertise to conduct one's work.
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Level 3 Behaviors
(Moderate Experience)
Updates our organizational knowledge database to reflect the latest industry developments.
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Level 4 Behaviors
(Extensive Experience)
Serves as an industry expert with deep domain knowledge to solve critical operational issues.
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Level 5 Behaviors
(Mastery)
Predicts the evolution of industry regulations and potential implications to our business.
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2 Core Competencies – Standard Operating Procedures (SOP)
Proficiency Level -3
Skill definition-A set of written instructions that describes the step-by-step activities to complete tasks in compliance with business standards and industry regulations.
Level 1 Behaviors
(General Familiarity)
Lists the typical processes of SOP development.
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Level 2 Behaviors
(Light Experience)
Supports the analysis of our business and operations processes for SOP design and development.
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Level 3 Behaviors
(Moderate Experience)
Researches new tools and techniques for SOP daily management.
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Level 4 Behaviors
(Extensive Experience)
Resolves complex issues arising from SOP practices; develops preventative solutions accordingly.
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Level 5 Behaviors
(Mastery)
Monitors industry for SOP trends and best practices; makes recommendations about those that benefit our business.
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3 Appeal Resolution Senior Manager - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Appeal Resolution Senior Manager
Proficiency Level - 4
5 Competency for - Appeal Resolution Senior Manager
Proficiency Level - 5

Summary of Appeal Resolution Senior Manager skills and competencies

There are 0 hard skills for Appeal Resolution Senior Manager.
8 general skills for Appeal Resolution Senior Manager, Document Management, Contract Compliance, Contract Review, etc.
13 soft skills for Appeal Resolution Senior Manager, Industry Knowledge, Standard Operating Procedures (SOP), Planning and Organizing, etc.
While the list totals 21 distinct skills, it's important to note that not all are required to be mastered to the same degree. Some skills may only need a basic understanding, whereas others demand a higher level of expertise.
For instance, as a Appeal Resolution Senior Manager, he or she needs to be proficient in Industry Knowledge, be skilled in Standard Operating Procedures (SOP), and be skilled in Planning and Organizing.

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