Also referred to as:
Grievance and Appeals Resolution Supervisor
Requirements and Responsibilities
Appeal Resolution Supervisor supervises a team of appeal resolution specialists to ensure timely and accurate handling of claim appeals and grievances. Assigns and monitors caseloads to meet established timelines, quality standards, and productivity targets. Being an Appeal Resolution Supervisor reviews appeal determinations and documentation to verify accuracy and adherence to procedures. Provides coaching, training, and technical guidance to support staff development and performance. Additionally, Appeal Resolution Supervisor resolves escalated or complex appeals and addresses inquiries from members, providers, and regulators. Ensures compliance with applicable regulations, accreditation standards, and company procedures. Requires a bachelor's degree. Typically reports to a manager. The Appeal Resolution Supervisor supervises a group of primarily para-professional level staffs. May also be a level above a supervisor within high volume administrative/production environments. Makes day-to-day decisions within or for a group/small department. Has some authority for personnel actions. To be an Appeal Resolution Supervisor typically requires 3-5 years experience in the related area as an individual contributor. Thorough knowledge of functional area and department processes.
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