Blue Cross NC · 7 hours ago
Team Leader, Appeals
Remote - North Carolina
Full-time
Remote
Mid, Senior Level
$55K/yr - $100K/yr
5+ years exp
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Responsibilities
Supervise staff for Member and Provider appeals as well as Utilization Management, Claims and Quality issue determinations.
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 or quality issues.
Work with staff to produce efficient and effective workflows and processes. Advise and instruct staff on meeting appeals 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.
Qualification
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Required
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
Benefits
Annual Incentive Bonus
401(k) with employer match
Paid Time Off (PTO)
Competitive health benefits and wellness programs
Company
Blue Cross NC
It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way.
5001-10000 employees
H1B Sponsorship
Blue Cross NC has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2023 (2)
2022 (5)
2021 (7)
2020 (11)
Funding
Current Stage
Late StageLeadership Team
Priscilla Alfaro
VP- Payment Integrity
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