Hybrid Appeals Supervisor - HMO & NCQA Compliance

Karmanos Cancer Institute; Flint (MI); Hybrid; USD 60,000 - 90,000; Full time

Job summary

McLaren Health Care in Flint, MI is seeking a Supervisor, Appeals to lead the appeals and grievances operations within McLaren Health Plan. This role focuses on ensuring regulatory compliance and efficient workflows across the department.

The successful candidate will oversee staff, develop policy, monitor performance, and prepare reports for leadership and regulators. This is a full-time, hybrid on-site position located in Flint, Michigan.

Qualifications

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

Responsibilities

• Provide overall supervision to appeals and grievances operations and ensure regulatory compliance.
• Develop and implement policies and procedures to ensure compliance with Appeals regulations.
• Create, adjust, and optimize workflows to improve department efficiency.
• Complete reports and statistics for senior management, regulators, auditors, and accrediting agencies.
• Analyze and implement training for staff.
• Monitor staff performance and take corrective action as needed.

Skills

Supervisory experience

Leadership

Staff training

Recruitment

Performance management

Training

Education

Associate degree in business, health care or related field

High school diploma with two years of related experience

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

Job description

McLaren Health Care in Flint, MI is seeking a Supervisor, Appeals to lead the appeals and grievances operations within McLaren Health Plan. This role focuses on ensuring regulatory compliance and efficient workflows across the department.

The successful candidate will oversee staff, develop policy, monitor performance, and prepare reports for leadership and regulators. This is a full-time, hybrid on-site position located in Flint, Michigan.