Grievances & Appeals Operations Leader

Prominence Health; Reno (NV); On-site; USD 85,000 - 120,000; Full time

Benefits offered by this job

Loan Forgiveness Program

Challenging and rewarding work environ

Competitive Compensation & Generous PT

Excellent Medical, Dental, Vision and

401(K) with company match and stock

SoFi Student Loan Refinancing Program

Career development opportunities

Benefits Website

Job summary

Prominence Health, part of Universal Health Services, seeks a leader to oversee Health Plan Operations' appeals and grievance functions in Reno. You will ensure timely, accurate responses to members, providers, and regulators and supervise the Grievance and Appeals team.

You’ll partner with leaders to identify process improvements, support investigations of member complaints, and train staff to deliver high-quality service while maintaining regulatory compliance across all lines of business.

Qualifications

• Two (2) years of healthcare management experience including increasing levels of responsibility.
• Two (2) years experience working with health plans insurance products or employer healthcare benefits programs.
• Two (2) years of experience specific to Grievances and Appeals.
• Four (4) years health plans or health insurance experience required, with a minimum of two (2) years experience specific to Grievances and Appeals.
• Knowledge of State and Federal regulations as they pertain to the health insurance industry.

Responsibilities

• Lead Health Plan Operations' appeals and grievance functions.
• Oversee staffing, development, guidance, and daily supervision of the Grievance and Appeals team.
• Provide administrative support to investigate and resolve member complaints, grievances, and provider disputes.
• Train staff in necessary skills and knowledge base; aid leadership in enhancing outcomes and operational efficiency.
• Collaborate with operational leaders to identify process improvement opportunities and ensure regulatory compliance.

Skills

Healthcare management

Grievances & appeals

Customer service

English communication

Data analysis

Education

Associate’s degree or equivalent experience

Tools

Microsoft Word

Excel

PowerPoint

Job description

Prominence Health, part of Universal Health Services, seeks a leader to oversee Health Plan Operations' appeals and grievance functions in Reno. You will ensure timely, accurate responses to members, providers, and regulators and supervise the Grievance and Appeals team.

You’ll partner with leaders to identify process improvements, support investigations of member complaints, and train staff to deliver high-quality service while maintaining regulatory compliance across all lines of business.