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Supervises a team responsible for the processing of appeals. Assigns and prioritizes cases. Responds to and resolves escalated issues. Coaches and trains team in the utilization of industry standards and best practices. Requires a bachelor's degree. Typically reports to a manager. 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. Typically requires 3 years experience in the related area as an individual contributor. Thorough knowledge of functional area under supervision.
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.
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