Healthcare Appeals & Grievances Supervisor

Prominence-Health-Plan; Reno (NV); On-site; USD 90,000 - 125,000; Full time

Benefits offered by this job

Loan Forgiveness

Rewarding work environment

Competitive compensation

Paid time off

Health plans (Medical, Dental, Vision,

401(k) with match

SoFi loan refinancing

Career development

Job summary

Prominence Health seeks a seasoned leader to head Health Plan Operations' appeals and grievance functions. You will manage a team responsible for timely, accurate responses to member, provider, and regulator inquiries across multiple lines of business.

The role includes staff development, process improvements, and ensuring regulatory compliance. In this capacity, you will collaborate with operational leaders to enhance outcomes, efficiency, and patient experience, while upholding high standards

Qualifications

• Two years of healthcare management experience with increasing responsibility.
• Two years experience with health plans or employer healthcare benefits programs.
• Two years of experience specific to Grievances and Appeals.
• Four years health plans experience with at least two years in Grievances and Appeals.
• Associate’s degree or equivalent experience.
• Knowledge of State and Federal regulations as they pertain to the health insurance industry.
• Ability to analyze statistical data to identify trends and opportunities for improved service quality.
• Excellent verbal and written communication in English.
• Experience with MS Word, Excel, PowerPoint.

Responsibilities

• Lead the Grievance and Appeals team and ensure timely responses to inquiries, grievances, and appeals across lines of business.
• Oversee staffing, guidance and daily supervision of the Grievance and Appeals team.
• Investigate and resolve member complaints, member grievances and provider disputes.
• Train staff and aid leadership in improving outcomes and operational efficiency.
• Collaborate with operational leaders to identify process improvements and ensure regulatory compliance.

Skills

Healthcare management

Grievances & Appeals

Regulatory compliance

English communication

Problem solving

Education

Associate degree

Tools

Microsoft Word

Excel

PowerPoint

Job description

Prominence Health seeks a seasoned leader to head Health Plan Operations' appeals and grievance functions. You will manage a team responsible for timely, accurate responses to member, provider, and regulator inquiries across multiple lines of business.

The role includes staff development, process improvements, and ensuring regulatory compliance. In this capacity, you will collaborate with operational leaders to enhance outcomes, efficiency, and patient experience, while upholding high standards