Cambia Health Solutions
We are dedicated to making the health care experience simpler, better and more affordable for people and their families.
Supervisor – Appeal Operations
Location
Idaho + 3 moreAll locations: Idaho, Oregon, Utah, Washington
Posted
4 days ago
Salary
$76.5K - $103.5K / year
Bachelor Degree5 yrs expExperience acceptedEnglish
Job Description
• Assigns and prioritizes work, sets goals, and coordinates daily activities of the team.
• Provides regular updates and communication to staff through 1:1 and team meetings.
• Monitors individual and team results to ensure work is completed in a timely manner, in accordance with department standards and procedures, and in compliance with medical policy and medical necessity guidelines.
• Assists in development of productivity and quality standards.
• Conducts or participates in compliance audits, reports audit findings, and identifies and implements process improvements as needed.
• Acts as a resource for staff and others.
• Appropriately escalates issues, partners with other departments to resolve issues and remove barriers and collaborates with physician advisors on complex cases.
• Participates in the hiring process and provides ongoing coaching, employee development, and performance reviews.
• Develops and maintains desk reference guides on work procedures, ensures new hires complete necessary training, and assesses training needs while playing an active role in staff development.
• Completes special projects as assigned and provides back-up support to staff as needed.
• May develop and present educational updates internally or to other departments.
• Seeks ideas and opportunities for continuous improvement, determines which opportunities should be pursued, and implements improvements as appropriate.
Job Requirements
- Bachelor's degree in healthcare or related field
- 3 years of leadership experience in the health insurance industry
- 5 years of claims review, customer service, or membership experience
- Equivalent combination of education and experience considered
- Coding experience strongly preferred
- Supervises 8-12 FTEs
- Demonstrated competency in setting priorities for a team and overseeing work outputs and timelines
- Ability to communicate effectively, both verbally and in writing
- Ability to effectively develop and lead a team, including employees in multiple locations or working remotely
- Demonstrated experience in recognizing problems and effectively resolving complex issues
- Familiarity with health insurance industry trends and technology
- Knowledge of medical terminology and payment coding guidelines, as applicable
- Experience with AI tools and technologies to enhance productivity and decision-making in professional settings (highly desired).
Benefits
- Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
- Annual employer contribution to a health savings account.
- Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
- Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
- Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
- Award-winning wellness programs that reward you for participation.
- Employee Assistance Fund for those in need.
- Commute and parking benefits.