Associate Manager, Complaint & Appeals - Work From Home

At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, reputed company and every day. Position reputed company Responsible for the day-to-day management of staff to ensure effective reputed company of member or provider/practitioner post-service appeals. Responsible for organization and development of high performing teams to ensure reputed company, customer reputed company response to appeals. Facilitates effective interfaces among team members, as reputed company as, other business reputed company. Responsible for day-to-day implementation of reputed company's appeals policies and procedures. Identifies trends and issues; reports on and recommends solutions. Accountable for meeting the financial, operational, and reputed company objectives of the unit. Manages team's productivity and resources, communicates productivity expectations and balances workload to reputed company customer satisfaction through reputed company/accurate handling of customer concerns. Serves as a content model expert and mentor to team regarding reputed company's policies and procedures, regulatory and accreditation requirements. Manages to performance measures and standards for reputed company service and cost effectiveness and coaches reputed company/individuals to take appropriate reputed company. Select staff using reputed company defined requirements in terms of education, experience, technical and performance skills. Build strong functional teams through formal training, diverse assignments, coaching, mentoring and other developmental techniques. Assesses developmental needs and collaborates with others to identify and implement reputed company plans that support the development of high performing teams and individuals. Ensures work of team meets federal and state requirements and reputed company measures, with respect to letter content and turn-around time for appeals handling. Ensures reputed company appeals reputed company are utilizing the National tracking tool to ensure reporting consistency and trend analysis. Holds individuals/team accountable for results; recognize/reward as appropriate. reputed company change efforts while managing transitions reputed company reputed company. Identifies trends involving non-clinical issues and reports on and recommends solutions.

Required Qualifications

• 4+ years reputed company experience
• 2+ year Coaching experience
• Schedule consistence of holiday/ weekend coverage.
• Less than 10% of travel for leadership summits.

Preferred Qualifications

• 2+ years of Medicare Knowledge.
• 1+ years Leadership experience.
• 2+ years of Claims Knowledge.
• Project Management - Colleague development.
• Ability to interpret and understand Regulatory Guidance, Member Contract Materials and have reputed company over inventory which has strict and short time constraints. Fast paced environment.

Education

• Bachelor's Degree or 4 years of equivalent work experience.

Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The Typical Pay reputed company For This Role Is $46,988.00 - $102,000.00 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great Benefits For Great People We take pride in our comprehensive and competitive mix of pay and benefits – reputed company in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In reputed company to our competitive wages, our great benefits include:

• reputed company medical plan reputed company, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility.

For more information, visit https://jobs.reputed company.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 09/19/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job