Grievances & Appeals Operations Supervisor

Universal Health Services; Reno (NV); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Loan Forgiveness Program

Challenging and rewarding work

Competitive Compensation & Generous FT

Excellent Medical, Dental, Vision and

401(K) with company match

SoFi Student Loan Refinancing Program

Career development opportunities

Job summary

Prominence Health, a value-based care organization within the UHS family, seeks an experienced leader to oversee Health Plan Operations' appeals and grievances in Reno, NV. You will manage the Grievance and Appeals team, respond to member and provider inquiries, and drive process improvements with operational leaders.

The role emphasizes regulatory compliance, staff development, and strong customer service, with collaboration across lines of business to improve outcomes and reduce costs.

Qualifications

• 2+ years of healthcare management experience with increasing responsibility
• 2+ years of experience with health plans insurance products or employer benefits
• 2+ years of experience specific to Grievances and Appeals
• 4+ years health plans or health insurance experience with at least 2 years in Grievances and Appeals
• Associate degree or equivalent experience
• Knowledge of State and Federal health insurance regulations
• Experience analyzing data to identify trends and opportunities for service improvements
• Excellent written and verbal English communication skills
• Proven ability to research and resolve processing issues independently
• Strong understanding of claims analytics and processing procedures
• Superior customer service skills with a root-cause mindset
• Strong organizational and problem-solving skills

Responsibilities

• Lead Health Plan Operations' appeals and grievance functions
• Ensure timely, accurate responses to inquiries and grievances across all lines of business
• Oversee staffing, development, guidance, and supervision of the Grievance and Appeals team
• Provide administrative support to investigate and resolve member complaints and disputes
• Train staff and support leadership in improving outcomes and efficiency
• Collaborate with operational leaders to identify process improvements and ensure compliance

Skills

Healthcare management

Grievances & Appeals

Regulatory knowledge

Data analysis

Communication

Education

Associate degree or equivalent experience

Tools

Microsoft Word

Excel

PowerPoint

Job description

Prominence Health, a value-based care organization within the UHS family, seeks an experienced leader to oversee Health Plan Operations' appeals and grievances in Reno, NV. You will manage the Grievance and Appeals team, respond to member and provider inquiries, and drive process improvements with operational leaders.

The role emphasizes regulatory compliance, staff development, and strong customer service, with collaboration across lines of business to improve outcomes and reduce costs.