[Hiring] Supervisor of Appeal Operations @Cambia Health Solutions

Role Description

This role involves supervising the Appeal Operations team and acting as a resource for Certified Professional Coders and non-clinical support staff.

• Oversees and coordinates team activities to achieve business objectives.
• Ensures timely processing of member and provider claims in alignment with contract provisions, proper coding, and regulatory compliance.
• Assigns and prioritizes work, sets goals, and coordinates daily activities of the team.
• Monitors individual and team results to ensure compliance with department standards and procedures.
• Assists in the development of productivity and quality standards.
• Acts as a resource for staff and collaborates with other departments to resolve issues.
• Participates in the hiring process and provides ongoing coaching and performance reviews.
• Completes special projects as assigned and provides back-up support to staff as needed.
• Seeks ideas and opportunities for continuous improvement and implements improvements as appropriate.

Qualifications

• 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

Requirements

• 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.