Team Lead, Grievance and Appeals

Job Summary

Overseeing the daily operations of grievance and appeals specialists, the full-time Team Lead, Grievance and Appeals will ensure compliance with regulatory and HIPAA guidelines while managing staff performance, conducting audits, and facilitating timely resolutions for member and provider issues in a remote setting.

Key responsibilities:

• Supervise staff performance, providing feedback and managing quality reviews
• Ensure compliance with Medicaid and Medicare processes and meet reporting deadlines
• Evaluate operations for process improvements and monitor grievances and appeals workflows

Required qualifications:

• Associate's Degree or equivalent relevant work experience
• Minimum of three years of customer service experience in an HMO or related industry
• Previous supervisory or leadership experience preferred
• Familiarity with healthcare and knowledge of Medicaid
• Basic computer skills, including proficiency in Microsoft Word, Excel, and PowerPoint