Supervisor, Grievance & Appeals
Posted on: 16 Feb 2021
Clayton, MO
Job Description
Position Purpose:
* Ensure that the Appeals & Grievance department processes all appeals, grievances and complaints in accordance with standards and the corporations policies and procedures
* Serve as a resource to the team regarding escalated or complex issues, process and systems issues, and regulatory updates
* Monitor and distribute teams case load and ensure adequate coverage
* Monitor and evaluate performance standards and provide daily feedback and guidance of problem resolution
* Identify and develop opportunities for process improvements and work with various departments to ensure problems are corrected to prevent recurrences
* Train and onboard new team membersSupervise the day to day operations of the Appeals and Grievance (A&G;) staff and functions within the department ensuring productivity and quality metrics are met. Support the team on escalated or complex issues and monitor and distribute case load.
Education/Experience:
Bachelors degree in a related field or equivalent experience. 2+ years of appeals and grievances processing experience in a healthcare or managed care setting preferred. Experience in healthcare law 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.
WellCare
Tampa, FL
WellCare Health Plans, Inc. provides government-sponsored managed care services. The company operates in three segments: Medicaid Health Plans, Medicare Health Plans, and Medicare Prescription Drug Plans (PDPs). The Medicaid Health Plans segment offers plans for beneficiaries of temporary assistance for needy families, supplemental security income, and aged blind and disabled residents; and other state-based programs, such as children's health insurance programs and long-term services and supports programs for qualifying families who are not eligible for Medicaid.
The Medicare Health Plans segment provides Medicare, a federal program that provides eligible persons aged 65 and over, as well as some disabled persons with a range of hospital, medical, and prescription drug benefits; Medicare Advantage, a Medicare’s managed care alternative to the original Medicare program, which offers individuals standard Medicare benefits directly through Centers for Medicare & Medicaid Services; and coordinated care plans that are administered through health maintenance organizations and require members to seek health care services and select a primary care physician from a network of health care providers.
The Medicare PDPs segment provides Medicare part D PDP plans to Medicare-eligible beneficiaries. Its PDP plans offer national in-network prescription drug coverage, including a preferred pharmacy network. As of December 31, 2018, the company served approximately 5.5 million members in the United States. WellCare Health Plans, Inc. was founded in 1985 and is headquartered in Tampa, Florida.
-
IndustryHealthcare
-
No. of Employees12, 000
-
Website
-
Jobs Posted917
