Team Leader, Appeals

Blue Cross NC; North Carolina; On-site; USD 67,000 - 107,000; Full time

Benefits offered by this job

Annual Incentive Bonus

401(k) with employer match

Paid Time Off (PTO)

Health benefits and wellness programs

Job summary

Blue Cross NC is seeking a Team Leader, Appeals in North Carolina to supervise the resolution of appeals, coding disputes and grievances in line with policies and guidelines. You will oversee daily operations and assign workloads to the team, ensuring timely and accurate outcomes.

The role requires a Bachelor’s or advanced degree or equivalent experience, with 5+ years in related work. Salary ranges from $66,998 to $107,197 and a robust Total Rewards package including bonus and retirement

Qualifications

• Bachelor's degree or advanced degree is required.

Responsibilities

• Supervise staff processing appeals, coding disputes and grievances.
• Set priorities and guide the team to meet organizational goals.
• Prepare for Appeals Committee and panel meetings.
• Handle difficult calls regarding appeals and grievances or quality issues.
• Instruct staff on provider/member communications and decisions.

Skills

Experience

Education

Bachelor's degree

Advanced degree

Job description

Job Description

We are hiring for a Team Leader, Appeals to supervise the process to ensure the resolution of appeals, coding disputes and grievances consistent with organizational policies and procedures and which are compliant with state and federal guidelines. This individual will oversee daily operations and case-load assignments and priorities for team.

Job Description

We are hiring for a Team Leader, Appeals to supervise the process to ensure the resolution of appeals, coding disputes and grievances consistent with organizational policies and procedures and which are compliant with state and federal guidelines. This individual will oversee daily operations and case-load assignments and priorities for team.

What You’ll Do

• Supervise staff responsible for the processing of appeals, coding disputes and grievances and coverage/organization determinations from members, member's representatives, providers, media outlets, senior leadership and regulatory agencies with established regulatory and accreditation guidelines.
• Take action, make decisions, and shape team or group priorities to reflect the organization’s core competencies. Guide and motivate others to take appropriate actions.
• Consult with appropriate staff in preparation of Appeals Committee and panel meetings.
• Handle and /or direct the handling of difficult customer calls regarding appeals, coding disputes and grievances or quality issues.
• Work with staff to produce efficient and effective workflows and processes. Advise and instruct staff on meeting team operational goals and policies. Instruct staff in communication to providers and members regarding decisions and supporting rationale, and respond to concerns on behalf of Medical Management.
• Evaluate data requests to ensure data requirements are being met. Assist staff employees and management with their information needs.
• Responsible for all related ad hoc reporting and assigned projects/interventions.
• Work with management to continuously improve operations, resolve cross-team issues, and allocate resources across the department and other divisions, as needed.

What You Bring

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

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

• Based on annual corporate goal achievement and individual performance.

$66,998.00 - $107,197.00

Skills

Case Management Supervision, Department Management, Employee Supervision, Healthcare Management, Information Management, Leadership, Managed Care, Mentorship, Operational Process Improvements, Organizing, Patient Care, People Management, Policy Management, Project Management, Resource Allocation Management, Resource Management, Supervision, Team Management, Utilization Management

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JOB ALERT FRAUD:

We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: [e-mail].