Finance Appeals Supervisor: Lead Compliance & Quality

Independence Blue Cross, LLC in; Philadelphia (Philadelphia County); On-site; USD 90,000 - 120,000; Full time

Job summary

Independence Blue Cross, LLC seeks a Supervisor Appeals (Finance) to lead the administrative appeals team, ensuring NCQA and state compliance and timely processing for Commercial and Self-Funded products. You will oversee intake, triage, documentation, and communications, coordinating with regulatory, quality, and operations partners.

The role emphasizes coaching staff, auditing results, and improving workflows in a fast-paced, highly regulated environment, with a focus on accuracy and member

Qualifications

• Bachelor's degree and 3+ years of experience in customer service, health plan operations, appeals/grievances, or similar setting; OR 5 years in an appeals role.
• Prior experience with appeals, grievances, compliance, or regulatory operations.
• Leadership or supervisory experience preferred.
• Strong understanding of PA Act 146 and NCQA regulatory requirements for appeals.
• Knowledge of Level Care and BCBS Global Solutions (formerly GeoBlue) products and operations preferred but not required.
• Excellent leadership, organizational, interpersonal, written, and verbal communication skills.
• Proven ability to analyze workflows, prioritize competing tasks, and manage time-sensitive processes.
• Ability to work independently and collaboratively in a fast-paced, highly regulated environment.
• Experience in vendor operations is preferred.
• Demonstrated skill in motivating, coaching, and supporting staff development.

Responsibilities

• Provides expertise, guidance, and technical support to ensure compliance with NCQA/state requirements and standards.
• Educates staff on new procedures, NCQA/state rule changes, and internal process improvements; monitors adoption for consistency.
• Coaches, develops, and motivates staff to achieve performance expectations and regulatory adherence.
• Oversees daily workflow of Appeals Specialists to ensure proper categorization and timely processing.
• Ensures intake, triage, case creation, tracking, letter generation, and documentation are done accurately in systems.
• Provides initial research and guidance on appeal issues per guidelines.
• Oversees vendor support operations for timely appeals processing.
• Conducts regular audits of closed appeals files for compliance and root-cause analysis.
• Ensures appeal notices adhere to state/NCQA standards and reflect clear, professional communication.
• Monitors data entry accuracy and documentation in appeals systems.
• Reviews management reports and oversees inventory to meet turnaround times and staffing needs.
• Identifies workflow barriers and recommends process improvements and policy adjustments.
• Collaborates with Business Analysts to maintain templates and system functionality.

Skills

Leadership

Coaching

Regulatory knowledge

Process improvement

Communication

Project management

Education

Bachelor's degree

Job description

Independence Blue Cross, LLC seeks a Supervisor Appeals (Finance) to lead the administrative appeals team, ensuring NCQA and state compliance and timely processing for Commercial and Self-Funded products. You will oversee intake, triage, documentation, and communications, coordinating with regulatory, quality, and operations partners.

The role emphasizes coaching staff, auditing results, and improving workflows in a fast-paced, highly regulated environment, with a focus on accuracy and member