Team Leader, Appeals

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

Job summary

Blue Cross and Blue Shield of North Carolina is seeking a Team Leader for Appeals to supervise the processing of appeals, coding disputes and grievances, ensuring alignment with policies and state/federal guidelines.

The role oversees daily operations, workload priorities, and coordination with regulators and leadership, while guiding staff toward efficient workflows and policy-compliant decisions. Hybrid flexibility is offered.

Qualifications

• 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.

Responsibilities

• Supervise staff handling appeals, coding disputes, and grievances and related determinations.
• Assign workload, set priorities, and improve workflows.
• Prepare for Appeals Committee meetings and interact with regulators.
• Provide guidance and coaching to staff on policies and operational goals.

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

Education

Bachelor's degree or 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.

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

$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

About Us

It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care – in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians. Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all. Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

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Request Accommodations

Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please notify HR at [e-mail].

Hybrid Flex

Blue Cross NC is a Hybrid Flex company. Whether the role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any of our approved states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.