Remote Appeals & Grievances Supervisor

GlobalHealth, Inc.; Oklahoma City (OK); Remote; USD 85,000 - 110,000; Full time

Job summary

GlobalHealth is a fast-growing Medicare Advantage HMO health insurer seeking a remote Appeals & Grievances leader. You will oversee daily operations, ensure timely resolution of appeals, and drive process improvements while maintaining PHI confidentiality.

Responsibilities include supervising the A&G team, coaching staff, reporting on critical metrics, and aligning workflows with regulatory requirements to ensure quality and compliance.

Qualifications

• 3 years member services and/or customer operations experience required.
• 2 years appeals and grievances required.
• 1 year experience with MS Office, Power BI, Mitel or CRM applications (Epic) required.
• Familiarity with process analytics and continuous improvement methodologies (lean, six-sigma, EOS, TOC) preferred.
• Medicare and/or NCQA experience preferred.

Responsibilities

• Schedule and balance available resources to match anticipated demand.
• Monitor and oversight of appeals and grievances process.
• Handle escalations for member issues.
• Manage employee time and attendance.
• Provide coaching and training of A&G team.
• Provide daily reporting for critical measures.
• Identify and execute on opportunities for improvement with workflow and structure.
• Manage daily workload for subordinates to ensure contractual and regulatory compliance.
• Perform hiring, coaching and disciplinary actions as required.
• Serve as primary representative and advocate for A&G issues in department leadership meetings.
• Must maintain confidentiality of PHI per HIPAA and company policy.

Skills

Prioritization

Detail orientation

Documentation

Independent problem solving

Results orientation

Education

High School diploma or GED

Associate degree or Bachelor’s degree preferred

Tools

MS Office

Power BI

Mitel

Epic CRM

Job description

GlobalHealth is a fast-growing Medicare Advantage HMO health insurer seeking a remote Appeals & Grievances leader. You will oversee daily operations, ensure timely resolution of appeals, and drive process improvements while maintaining PHI confidentiality.

Responsibilities include supervising the A&G team, coaching staff, reporting on critical metrics, and aligning workflows with regulatory requirements to ensure quality and compliance.