Appeals Supervisor (Hybrid) – Lead Compliance & Ops

Mclaren-Health-Care; Flint (MI); Hybrid; USD 65,000 - 95,000; Full time

Job summary

McLaren Health Plan is seeking a Supervisor, Appeals to lead the appeals and grievances team, ensuring compliant, timely processing of member appeals and denials, and achieving quality outcomes.

This hybrid role requires on-site presence in Flint, MI on scheduled days, with responsibilities including policy development, reporting, and staff training to optimize workflow and regulatory adherence. Experience with NCQA accreditation is a plus and strong leadership is essential.

Qualifications

• Associate degree or high school diploma with two years of related experience.
• Two years’ experience in an HMO/Managed Care operations role.
• Bachelor’s degree preferred.
• Two years’ supervisory experience leading a staff of five or more.
• Five years progressive leadership in group health plan operations.
• Three years’ experience in HMO/Managed Care accreditation processes (e.g., NCQA).

Responsibilities

• Provides overall supervision to appeals and grievances operations.
• Maintains compliance with state and NCQA Appeals regulations.
• Develops and implements policies and procedures for Appeals.
• Creates reports and statistics for senior management and regulators.
• Analyzes and trains staff; optimizes workflows.

Skills

Supervisory experience

Leadership

HMO/Managed Care operations

Education

Associate degree in business, health care or related field

Bachelor’s Degree in business, health care or related field

Job description

McLaren Health Plan is seeking a Supervisor, Appeals to lead the appeals and grievances team, ensuring compliant, timely processing of member appeals and denials, and achieving quality outcomes.

This hybrid role requires on-site presence in Flint, MI on scheduled days, with responsibilities including policy development, reporting, and staff training to optimize workflow and regulatory adherence. Experience with NCQA accreditation is a plus and strong leadership is essential.