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Manages the grievance process to review, investigate, document, process, negotiate, and resolve disputed medical, insurance, and other claims. Oversees work activity that is compliant with all regulatory guidelines and policy protocols. Allocates team resources to ensure an effective and balanced case workload. Applies industry standards and uses best practices in the preparation of legal briefs. May represent the organization at hearings. Requires a bachelor's degree. Typically reports to a senior manager or head of a unit/department. 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. 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.
Directs the overall grievance and appeal process operations that encompass the review, investigation, negotiation and processing of disputed medical, insurance, and other claims. 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. Requires a bachelor's degree. Typically reports to a senior manager or head of a unit/department. Typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Typically requires 3+ years of managerial experience. Capable of resolving escalated issues arising from operations and requiring coordination with other departments.
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