Pennsylvania Appeals Supervisor

Job Summary

A company is looking for a Supervisor of Appeals and Grievance Case Resolution.

Key Responsibilities

• Supervise daily activities of Appeals & Grievance staff, including scheduling and workload distribution
• Monitor operational goals, review case documentation for compliance, and assist in workflow improvements
• Conduct routine audits, track operational metrics, and coordinate with cross-functional teams for resolution of cases

Required Qualifications

• Associate Degree in Health Administration, Business, or related field
• Minimum of 3 years of experience leading a team in a healthcare setting
• At least 5 years of experience in healthcare operations or grievance/appeals coordination
• Knowledge of CMS, NCQA, and state-specific appeals and grievance requirements
• Experience overseeing complex cases within a managed care organization