Supervisor Grievance & Appeals

Job Details

Job Summary

Building Brighter Futures... One Smile at a Time!

This position is Fully Remote, Near one of our Office Locations :

Tustin, CA - Las Vegas, NV - Oklahoma City, OK - Uniondale, NY - Tampa, FL

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.

Key Responsibilities :

• 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.

What You'll Need :

• 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. Please be prepared to Complete an Online Skills Assessment as part of the Application process!
• 4-year bachelor's degree is preferred, or equivalent combination of education and work experience.
• Minimum 2 years' experience in Grievances and Appeals processing .
• Minimum 1 years' experience as a supervisor or similar management role.

LOCATION

Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States.

WHAT LIBERTY OFFERS

Happy, healthy employees enhance our ability to assist our members and contribute more actively to their society. That’s why LIBERTY offers competitive and attractive benefit packages for their employees.

We strive to care for employees in positive ways that promote wellness and productive employees.

Our first-class benefit package supports our employees and their dependents with :

• Competitive pay structure and saving options that help you reach your financial goals.
• Excellent 401k retirement benefits available which includes employer match and ability to save via a Roth IRA, plus immediate vesting during Safe Harbor period and professional financial advice through Financial Engines!
• Medical insurance offered with low-cost premium for employee only coverage and LIBERTY subsidizes 50% of dependent coverage for eligible enrolled dependents.
• 100% employer paid dental coverage for employees and eligible dependents.
• 100% employer paid vision coverage for employee only coverage, low-cost premium for dependents!
• Company paid basic life and AD&D coverage; options to elect additional supplemental coverage.
• Long Term Disability coverage
• Expansive wellness program including companywide Get Active challenges and Burn-A-Long with option for gym discounts.
• Employee Assistance Program
• Generous vacation and sick leave with the ability to roll time over.
• 10 paid company holidays
• Tuition Reimbursement
• Remote or Hybrid options for various positions
• And so much more...

COMPENSATION

In the spirit of pay transparency, we are excited to share the base salary for this position is $58,760 - $76,388, exclusive of fringe benefits or potential bonuses.

If you are hired at LIBERTY, your final base salary compensation will be determined based on factors such as geographic location, skills, education, and / or experience.

In addition to those factors we believe in the importance of pay equity and consider internal equity of our current team members as a part of any, final offer.

Please keep in mind that the range mentioned above is the full base salary range for the role. Hiring at the maximum of the range would not be typical in order to allow for future & continued salary growth.

LIBERTY Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives.

We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential.

LIBERTY will leverage diverse perspectives in building high performance teams and organizational culture.

LIBERTY Dental Plan will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve.

We comply with all applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements.

Sponsorship and Relocation Specifications :

LIBERTY Dental Plan is an Equal Opportunity Employer / VETS / Disabled.

No relocation assistance or sponsorship available at this time.