Senior Appeals & Grievances Supervisor (Remote)

GlobalHealth; Oklahoma City (OK); Remote; USD 65,000 - 90,000; Full time

Job summary

GlobalHealth is a Medicare Advantage health insurer seeking a Remote Appeals and Grievances Supervisor to lead daily operations, ensure timely resolution, and maintain regulatory compliance for member grievances.

You will coach the A&G team, manage workload, report on critical metrics, participate in hiring and disciplinary actions, and protect PHI under HIPAA while collaborating with department leadership.

Qualifications

• High School diploma or GED required.
• Associate degree or bachelor’s preferred.
• 3 years member services or customer operations experience required.
• 2 years appeals and grievances experience required.
• 1 year experience with MS Office, Power BI a plus, Mitel or CRM software (Epic) required.
• Familiarity with process analytics and continuous improvement methodologies (lean, six-sigma, EOS, TOC) preferred.
• Medicare and 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 and concerns in department leadership meetings.
• Must maintain confidentiality of PHI, per HIPAA and company policy.

Skills

Prioritization

Documentation

Problem-solving

Independence

Multitasking

Education

High School diploma or GED

Associate degree or Bachelor’s preferred

Tools

MS Office

Power BI

Mitel

CRM (Epic)

Job description

GlobalHealth is a Medicare Advantage health insurer seeking a Remote Appeals and Grievances Supervisor to lead daily operations, ensure timely resolution, and maintain regulatory compliance for member grievances.

You will coach the A&G team, manage workload, report on critical metrics, participate in hiring and disciplinary actions, and protect PHI under HIPAA while collaborating with department leadership.