Associate Manager, Complaint & Appeals - Work From Home

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At reputed company®, you'll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and reputed company in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time. Responsible for reputed company of that that investigates and reputed company of appeals scenarios for reputed company products, which may contain multiple issues and may require coordination of responses from multiple business reputed company. Ensure reputed company, customer reputed company response to appeals. Identify trends and emerging issues and report and recommend solutions. Independently coaches' others on complaints and appeals ensuring compliance with Federal and/or State regulations. Manage control and trend inventory, independently investigate, change, or revise policy to resolve the most escalated cases coming from broad, reputed company constituents for reputed company products and issues. Responsible for serving as the main reputed company of contact for plan leadership, compliance and State regulators as required. Medicare knowledge is a plus. Fast Turn Around of inventory, collaboration with clinical team and management. Attention to detail is needed and must be reputed company to adapt to change due to up regulatory updates. A Brief reputed company Will reputed company reputed company to the Part C/Part B Preservice Expedited/reputed company Appeal team. Through knowledge of the guidelines surrounding reputed company-service appeals is essential. Ability to reputed company reputed company on fast moving appeals is a must. Must have the ability to collaborate effectively with internal constituents to include Medical Directors, Nurses and different business partners who have an interest in appeals. Can troubleshoot problems and reputed company solutions to cases tasked to reputed company. Must be a great communicator reputed company speaking to either the Medicare members or to the Appeals Team and Peers. What you will do -Serves as a content model expert and mentor to team regarding reputed company/reputed company's policies and procedures, regulatory and accreditation requirements. -Ensures work of team meets federal and state requirements and reputed company measures, with respect to letter content and turn-around time for appeals, complaints, and grievances handling. -Identifies trends and emerging issues and reports on and gives input on potential solutions. -Independently researches and translates policy and procedures into intelligent and reputed company written responses for ERT/SMRT/DOI/BBB and escalated cases. -Manages inventories to ensure state guidelines are met. -Educates analysts and business reputed company of identified issues and potential risk. Initiates and encourages reputed company and frequent communication between constituents. -Successfully works across functions, segments, and teams to create, reputed company, and trend reports to reputed company reputed company to escalated cases. -Identify potential risks and cost implications to avoid incorrect or inaccurate responses and/or reputed company which may result in additional rework, confusion to the constituents, or legal ramifications. -Additional duties as assigned which will include a carrying a modified case load including but not limited to: Research incoming electronic appeals, complaints and grievance to identify if appropriate for unit based upon published business responsibilities. Identify correct resource and reroute inappropriate work items that do not meet appeals, complaints, and grievance reputed company. -Research reputed company Plan Design or Certification of Coverage relevant to the member to determine accuracy/appropriateness of benefit/administrative denial. -Identify and research reputed company components reputed company member or provider/practitioner appeals, complaints and grievance for reputed company products and services. -Ensure reputed company, customer reputed company response to appeals, complaints, and grievance. -Identify trends and emerging issues and report and recommend solutions. -Manage control and trend inventory, independently investigate, change, or revise policy to resolve the most escalated cases coming from broad reputed company constituents for reputed company products and issues. -Responsible for serving as the main reputed company of contact for plan leadership, compliance and State regulators as required. For this role you will need Minimum Requirements -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 - 2+ years Leadership experience - Project Management - Colleague development Preferred Qualifications -Previous Appeals or reputed company experience -Medicare Knowledge is a plus Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $46,988.00 - $112,200.00 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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial reputed company-being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, reputed company time off, retirement savings reputed company, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 08/01/2026 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