Remote Appeals Team Lead — Operations & Compliance

Blue Cross and Blue Shield of North Carolina; Northern (KY); Hybrid; USD 67,000 - 107,000; Full time

Benefits offered by this job

Annual Incentive Bonus

401(k) with employer match

PTO

Health benefits

Wellness programs

Job summary

Blue Cross NC is seeking a Team Leader, Appeals to supervise the process to ensure timely resolution of appeals, coding disputes and grievances in line with organizational policies and federal guidelines. You will oversee daily operations and workload priorities for the team.

This role requires a bachelor's degree or advanced degree with 5+ years in a related field (7+ years if no degree). The position is full-time with remote flexibility in North Carolina and offers a robust Total Rewards

Qualifications

• Bachelor's degree or advanced degree (where required).
• 5+ years experience in related field; in lieu of degree, 7+ years experience.

Responsibilities

• Supervise staff processing of appeals, coding disputes and grievances.
• Oversee daily operations and workload priorities.
• Prepare for Appeals Committee and panel meetings.
• Guide staff in communication to providers and members.
• Improve workflows and processes within the team.
• Manage ad hoc reporting and project interventions.

Skills

Staff supervision

Case management

Leadership

Healthcare management

Regulatory knowledge

Operations improvement

Team prioritization

Communication with providers/matters

Education

Bachelor's degree

Advanced degree

7+ years experience in related field (no degree)

Job description

Blue Cross NC is seeking a Team Leader, Appeals to supervise the process to ensure timely resolution of appeals, coding disputes and grievances in line with organizational policies and federal guidelines. You will oversee daily operations and workload priorities for the team.

This role requires a bachelor's degree or advanced degree with 5+ years in a related field (7+ years if no degree). The position is full-time with remote flexibility in North Carolina and offers a robust Total Rewards