Skills & Competencies for Appeal Resolution Senior Manager

Appeal Resolution Senior Manager job profile

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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%
$141,914
TOTAL 50%
$165,527
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.
JOB FAMILY COMPETENCIES CORE COMPETENCIES
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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)
Describes the importance and purpose of document management in retrieving relevant work documents.
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Level 2 Behaviors
(Light Experience)
Compiles documents for scanning, indexing, and uploading to web-based management applications.
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Level 3 Behaviors
(Moderate Experience)
Handles the scanning and uploading of mailed documents into your organization's document systems.
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Level 4 Behaviors
(Extensive Experience)
Facilitates document management efforts to improve information workflow and data security.
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Level 5 Behaviors
(Mastery)
Develops key performance indicators of document management to evaluate and drive documentation metric success.
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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)
Describes the concepts of conformance with regulations and obligations in contract compliance.
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Level 2 Behaviors
(Light Experience)
Assists management in identifying and mitigating risks while ensuring compliance with all contract terms.
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Level 3 Behaviors
(Moderate Experience)
Checks the business contracts to ensure effectiveness and compliance with policies and procedures.
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Level 4 Behaviors
(Extensive Experience)
Evaluates contractual performance to check compliance and conflicts requiring resolution at contract renewal.
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Level 5 Behaviors
(Mastery)
Creates a robust process to measure and enforce contract compliance.
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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)
Describes the entire value chain of the industry.
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Level 2 Behaviors
(Light Experience)
Documents industry and domain knowledge in appropriate documentation systems.
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Level 3 Behaviors
(Moderate Experience)
Gathers and analyses market intelligence to drive operational optimization.
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Level 4 Behaviors
(Extensive Experience)
Demonstrates intimate knowledge of industry and market trends to provide business insights.
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Level 5 Behaviors
(Mastery)
Establishes organizational policies and processes to seek out and understand industry dynamics.
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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)
Describes the purposes and benefits of Standard Operating Procedures (SOP).
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Level 2 Behaviors
(Light Experience)
Compiles and maintains SOPs under our current policies and directions.
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Level 3 Behaviors
(Moderate Experience)
Implements the use of SOP throughout our business to drive efficiency.
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Level 4 Behaviors
(Extensive Experience)
Enhances the SOP management system to improve efficiency and user experience.
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Level 5 Behaviors
(Mastery)
Designs a Standard Operating Procedure (SOP) strategy to align with our business objectives.
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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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