Member Services Supervisor – Appeals & Resolution Lead

Community First Health Plans; San Antonio (TX); On-site; USD 60,000 - 80,000; Full time

Job summary

Community First Health Plans seeks a Supervisor to lead the Member Services Resolution Unit handling STAR, STAR Kids, CHIP, Medicare Advantage, and Commercial members. You will supervise staff and guide resolution of benefits and appeals.

Ensure HIPAA compliance, coordinate with Service Coordination and Care Management, assist with written communications, and provide information to appeal panels and regulators as appropriate. Leadership and training of staff are required.

Qualifications

• Bachelor’s degree in business, health care or related field with at least two years’ experience in the managed care industry.
• Minimum of four years of supervisory work in health care administration; experience may substitute for college education. Complaints and appeals resolution or quality improvement management experience is preferred.

Responsibilities

• Supervise and direct activities of Member Advocates and staff in the Member Services Resolution Unit.
• Ensure HIPAA compliance across operations and coordinate with Service Coordination and Care Management.
• Assist with responses via written correspondence and secure email.
• Provide information to appeal panels, employer groups and/or regulatory agencies as appropriate.

Skills

Supervisory experience

HIPAA compliance

Member services

Communication

Education

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

Job description

Community First Health Plans seeks a Supervisor to lead the Member Services Resolution Unit handling STAR, STAR Kids, CHIP, Medicare Advantage, and Commercial members. You will supervise staff and guide resolution of benefits and appeals.

Ensure HIPAA compliance, coordinate with Service Coordination and Care Management, assist with written communications, and provide information to appeal panels and regulators as appropriate. Leadership and training of staff are required.