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Supervisor Grievance & Appeals

Company: LIBERTY Dental Plan
Location: Irvine
Posted on: November 26, 2022

Job Description:

The Supervisor Grievances and Appeals, under the direction of the Manager Grievances and Appeals, is responsible for supervision of the Grievances and Appeals unit, daily staff productivity, work distribution and administrative support as they receive, investigate and resolve member complaints, Member grievances, and provider disputes. This role also includes administrative duties related to activities within the Quality Management department including participation in cross functional workgroups, teams and committees as assigned. The Supervisor will also monitor quality and workflow, oversee inventory, and ensure production requirements are met per contractual service agreements. May research and resolve written Regulatory Agency complaints including but not limited to those from the Department of Insurance and complex or multi-issue provider complaints submitted by members and/or providers.

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Job Summary Details*

* Supervise the day-to-day operations of the Grievances and Appeals staff and functions within the department ensuring productivity and quality metrics are met.
* Balance and adjust case load assignments, as required, to achieve the most effective performance and ensure timeliness standards are met.
* Serve as a subject matter expert and resource on complaint and appeal processes, escalated or complex case issues, and system issues related to the research and resolution of grievances, appeals and provider disputes programs.
* Ensure consistency in execution across team, holds staff accountable for following established policies, effectively communicate client expectations, regulatory requirements to ensure compliance with member and provider complaint and appeal letters.
* Strategically evaluate the needs of the department and recommend changes as appropriate.
* Assist with interviews, hiring, and responsible for training dept. staff to align efforts with established objectives and processing goals.
* Maintains strong client relationships.
* Perform other job-related duties as assigned or determined appropriate.

*Education/Experience*

* 4 Year / Bachelor's Degree or equivalent work experience
* 2 - 5 years of grievances and appeals processing.
* 1 - 2 years of experience as a supervisor or similar.

*Specific Skills/Knowledge*

* Excellent time management skills, along with the ability to meet strict internal and regulatory deadlines with highly confidential information.
* Ability to establish and maintain effective interpersonal relationships with all levels of staff, other programs, agencies, and the public.
* Excellent written, verbal and electronic communication skills, prioritization, decision-making, problem analysis/resolution, team building, training, and leadership.
* Intermediate knowledge of Microsoft Office programs including Word, Excel, and Outlook.

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Work Environment*
Work is generally performed within an office environment, with standard office equipment available. Sedentary work involves extensive sitting, typing, close range vision most of the time.
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Sponsorship and Relocation Specifications:
LIBERTY Dental Plan is an Equal Opportunity Employer / VETS / Disabled.
_No relocation assistance or sponsorship available at this time._

Job Type: Full-time%58047475%

Keywords: LIBERTY Dental Plan, Irvine , Supervisor Grievance & Appeals, Other , Irvine, California

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