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Supervisor, Appeals Grievance

Chicago, Illinois Apply Now Job ID 1161390 Category Leadership Organization IlliniCare Health Plan Schedule Full-time

Position Purpose: The Supervisor of Appeals & Grievances is accountable for the recruitment, hiring, promotion, counseling, and daily supervision of Grievance and Appeals Specialists and administrative support as they receive, investigate and resolve member complaints, member grievances, and provider disputes. This position is also responsible for the coordination of the resolution of grievance situations requiring competent and effective resolution in compliance with legal and regulatory requirements. This position will also perform initial and ongoing training in necessary skills and knowledge base and will assist Manager of Grievance and Appeals to establish and maintain procedures for Unit to maximize both outcomes and operational efficiency.

  • Provides daily supervision for Grievance and Appeals Unit, including coordination of backup staffing, cross-training and deployment.
  • Performs recruiting, hiring, promotion, and performance evaluation tasks and counsels non-clinical Grievance and Appeals staff.
  • Orients and trains new Grievance and Appeals Unit members.
  • Continually trains Unit members concerning grievances, appeals, and provider disputes/appeals.
  • Regularly audits work of G&A Specialists and reports results.
  • Coordinates investigation and resolution of complex appeal and grievance issues.
  • Provides approval decisions involving grievance and appeal determinations.
  • Coordinates maintenance and updates of desktop procedures and manuals for Unit.
  • Assists in the establishment of grievance operating procedures.
  • Prepares reports as required and performs trend analyses.
  • Participates in Health Plan audits as needed.
  • Performs other related duties as required.

  • Qualifications:

    Education/Experience: High School Diploma. Bachelor’s Degree preferred. 5+ years of experience in Managed Care. 2+ supervisory experience preferred.

    Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

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