Team Leader, Appeals

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

## Team Leader, AppealsApply: Remote Flex - North Carolina: Full time: Posted Today: End Date: September 25, 2026 (9 days left to apply): RQ0019345**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