And Qualifications ESSENTIAL DUTIES & RESPONSIBILITIES Lead and manage staff by providing regular feedback, managing work assignments and helping the staff grow their skills and capabilities to meet the needs of the department/position. Facilitate regular unit meetings to foster communication and drive performance. Regularly review staff case work using all tools available and provide coaching and training to improve skills and drive standardization throughout the department. Comply with CBC Hum... more details
Supervisor Appeals and Grievance Resolution
Job LocationsUS-PA-Harrisburg
Workplace
Hybrid
Employment Type
Full Time
ID
2024-2985
Position Description
At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” The Supervisor, Appeals and Grievances Resolution, in the Operations area is responsible for overseeing a team of non-clinical staff in the day-to-day workflow processes of the Provider and/or Member Appeal functions. Provides support and guidance daily to the Appeals Provider or Member team in performing their assignments, monitoring the successful delivery and adherence to policies and procedures, as well as supervising daily performance, quality, attendance, and ensures that the department and corporate goals are met. Additionally, the Supervisor assists the Manager with all appeal project efforts specific to their teams’ processes. The Supervisor facilitates collaboration between AGR Specialists, other members of the AGR Team, and both internal and external CBC business partners
Responsibilities and Qualifications
ESSENTIAL DUTIES & RESPONSIBILITIES
Lead and manage staff by providing regular feedback, managing work assignments and helping the staff grow their skills and capabilities to meet the needs of the department/position.
Facilitate regular unit meetings to foster communication and drive performance. Regularly review staff case work using all tools available and provide coaching and training to improve skills and drive standardization throughout the department. Comply with CBC Human Resources Performance Management processes.
Performs primary inventory management and ensures that work is distributed appropriately in order to meet defined production standards as well as turnaround times. Collaborates with department Appeals Analyst(s) to ensure that all job aids, training documents, departmental policies, desktop procedures, and letter templates are current and up to date.
Acts as a liaison between AGR and other business units as it pertains to the Appeals processes, and provides relevant feedback as well as suggestions for improvement that other business units can exercise to ensure success to the Appeals specific compliance and regulatory standards. Answers internal and external customer questions, assists peers, Manager, or Director with tasks.
Serves as first line contact for associates in his/her work group. Make recommendations and lead process improvements as needs are identified. Lead and assist on departmental project efforts as needed.
About Us
We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a diverse and caring team of supportive colleagues, and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career.
And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.
Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association. We are an equal opportunity/affirmative action employer and do not discriminate on the basis of race, color, religion, national origin, gender, sexual orientation, gender identity, age, genetic information, physical or mental disability, veteran status, or marital status, or any other status protected by applicable law.
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