Also referred to as:
Grievance and Appeals Resolution Manager
Requirements and Responsibilities
Appeal Resolution Manager manages the appeal resolution team to ensure accurate, timely, and compliant handling of claim appeals and grievances. Oversees the review, investigation, and disposition of appeals in accordance with regulatory and contractual requirements. Being an Appeal Resolution Manager promotes established procedures and quality standards to ensure consistency and compliance. Reviews complex or escalated appeals and provides technical guidance to staff. Additionally, Appeal Resolution Manager monitors turnaround times, overturn rates, and quality results to meet departmental goals. Ensures compliance with applicable regulations, accreditation standards, and company policies. Requires a bachelor's degree. Typically reports to a director. The Appeal Resolution Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. To be an Appeal Resolution Manager typically requires 5 years experience in the related area as an individual contributor. 1-3 years supervisory experience may be required. Extensive knowledge of the function and department processes.
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