Manager, Appeals & Grievances — Change Leader

Blue Cross & Blue Shield of Minnesota; Eagan (MN); Hybrid; USD 102,000 - 174,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

401k

Paid Time Off (PTO)

Volunteer Paid Time Off (VPTO)

Job summary

Blue Cross and Blue Shield of Minnesota is seeking a strategic leader to own the escalated corporate appeal process and guide cross-functional teams through complex regulatory and operational challenges.

You will drive continuous improvement, partner with Compliance and Audit teams, and manage resources to meet aggressive timeliness and accuracy goals. This hybrid role leverages strong analytics and vendor management experience.

Qualifications

• 5+ years of progressive customer service/operations experience, with 1+ staff, team lead or project lead experience.
• Bachelor’s degree; in lieu of a degree, an additional two years of relevant experience beyond the qualifications listed above may be accepted.

Responsibilities

• Owns the escalated corporate appeal process (pre and post review) for the Corporate Appeals Committee, interfacing with legal and external counsel.
• Lead internal workgroups/committees for core projects affecting workflows and vendor relationships.
• Evaluate appeals and drive implementation of new technical solutions to increase efficiency and capabilities.
• Act as change agent, champion organizational initiatives, and foster a culture of continuous improvement.
• Analyze appeals operational reporting and communicate trends to senior leadership and partners.
• Coordinate with enterprise partners to streamline processes and ensure compliance and audit readiness.

Skills

Customer service

Operations

Team leadership

Project leadership

Education

Bachelor’s degree

Master’s degree

Job description

Blue Cross and Blue Shield of Minnesota is seeking a strategic leader to own the escalated corporate appeal process and guide cross-functional teams through complex regulatory and operational challenges.

You will drive continuous improvement, partner with Compliance and Audit teams, and manage resources to meet aggressive timeliness and accuracy goals. This hybrid role leverages strong analytics and vendor management experience.