Manager Grievance Appeals Salary in Columbia, SC

Grievance and Appeals Resolution Manager - Average Salary $93,120

The Grievance and Appeals Resolution Manager oversees research, investigation, negotiation and resolution of all types of appeals and grievances. Plans, organizes, and directs the work activity of the appeal and grievance team consistent with organizational policies and procedures and which is compliant with state and federal guidelines. Being a Grievance and Appeals Resolution Manager requires a bachelor's degree. Prepares formal briefs and appears at hearings as a representative of the organization. In addition, Grievance and Appeals Resolution Manager typically reports to a manager or head of a unit/department. The Grievance and Appeals 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. Extensive knowledge of department processes. Working as a Grievance and Appeals Resolution Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required.

Grievance and Appeals Resolution Specialist - Average Salary $48,730

The Grievance and Appeals Resolution Specialist contacts customers to gather information and communicate disposition of case. Logs, tracks, and processes appeals and grievances. Being a Grievance and Appeals Resolution Specialist builds case files for each grievance and ensures compliance with organizational and regulatory guidelines. Conducts pertinent research in order to evaluate, respond to, and close appeals. In addition, Grievance and Appeals Resolution Specialist requires a bachelor's degree. Typically reports to a supervisor or manager. Being a Grievance and Appeals Resolution Specialist gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. Working as a Grievance and Appeals Resolution Specialist typically requires 2 to 4 years of related experience.

Grievance and Appeals Resolution Nurse - Average Salary $84,100

The Grievance and Appeals Resolution Nurse reviews applicable medical records and assesses clinical data to investigate and resolve disputes over the medical necessity for services, approvals, pre-certifications, or other cases. Conducts the medical review activities needed to resolve and process clinical appeals and claims. Being a Grievance and Appeals Resolution Nurse documents cases according to guidelines and standard procedures. Understands and interprets applicable medical terminology, clinical procedures, regulations and policies. In addition, Grievance and Appeals Resolution Nurse prepares the documentation required for further medical review, hearings, and different appeal processes. Typically requires a bachelor's degree in nursing or equivalent. Requires a Registered Nurse (RN) license. Typically reports to a manager. Being a Grievance and Appeals Resolution Nurse work is generally independent and collaborative in nature. Contributes to moderately complex aspects of a project. Working as a Grievance and Appeals Resolution Nurse typically requires 4 -7 years of related experience.

Grievance and Appeals Resolution Supervisor - Average Salary $68,610

The Grievance and Appeals Resolution Supervisor monitors the research, investigation, negotiation and resolution of all types of appeals and grievances. Supervises a team responsible for review of appeals and grievances to ensure the resolutions are legal and follow company guidelines and procedures. Being a Grievance and Appeals Resolution Supervisor typically reports to a manager or head of a unit/department. Requires a bachelor's degree. The Grievance and Appeals Resolution Supervisor supervises a small group of para-professional staff in an organization characterized by highly transactional or repetitive processes. Contributes to the development of processes and procedures. Thorough knowledge of functional area under supervision. Working as a Grievance and Appeals Resolution Supervisor typically requires 3 years experience in the related area as an individual contributor.

Grievance and Appeals Resolution Manager, Sr. - Average Salary $133,300

The Grievance and Appeals Resolution Manager, Sr. ensures that work activities are compliant with all regulatory guidelines and policy protocols. Directs the overall grievance and appeal process operations that encompass the review, investigation, negotiation and processing of disputed medical, insurance, and other claims. Being a Grievance and Appeals Resolution Manager, Sr. provides expert subject matter guidance and may represent the organization at hearings. Allocates resources to ensure an effective and efficient case workload that achieves operational objectives. In addition, Grievance and Appeals Resolution Manager, Sr. requires a bachelor's degree. Typically reports to a senior manager or head of a unit/department. The Grievance and Appeals Resolution Manager, Sr. 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. Working as a Grievance and Appeals Resolution Manager, Sr. typically requires 3+ years of managerial experience. Capable of resolving escalated issues arising from operations and requiring coordination with other departments.