The Grievances Supervisor is an important part of the Grievances Program, which is the heartbeat of Plan operations and a direct insight to member experience. The primary responsibility of the Supervisor is to lead a diverse team of specialists investigating and solving member concerns/problems, answer questions, escalate issues, remove barriers, mitigate risks, and make quick decisions to ensure cases are fully investigated within the timeframe. This role is also accountable for monitoring staff performance against Company standards, coaching and conducting performance reviews, training new staff, updating training documents, departmental policies and operating procedures, daily management of workload, and maintaining open communication throughout the day with on-site and remote team members. This position will have a will also maintain a workload of cases and serves as back-up as needed to work cases This individual must be committed to finding and resolving issues and improving processes, while maintaining timeliness and quality standards for investigation and resolution.
- Manages and monitors day-to-day operations, workloads, and activities of the team to ensure timeliness and quality measures are met and in accordance with administrative and departmental policies and procedures.
- Monitors all staff needs, including training requirements, quality, and production.
- Provides counsel on performance issues.
- Meets with the team daily to ensure grievances are being appropriately investigated.
- Ensures grievance investigation and resolution reflects the member’s complaint and accurately and completely addresses all components of the complaint.
- Leads case status meetings and assist with decision making.
- Oversees the monitoring function of the grievance team.
- Ensures the quality of verbal and written communications with members, vendors, and Clients.
- Works with departments and subject matter experts to identify potential for broader impact and appropriate corrective actions.
- Builds and maintains good rapport and work effectively with individuals in all areas of the Company.
- Recognizes urgent and sensitive issues/incidents and escalate to management in a timely manner to facilitate appropriate and timely response.
- Communicates the status of assignments to leadership and team in weekly internal meetings for discussion and decision-making.
- Perform special projects as needed.
- High School diploma or equivalent, with bachelor’s degree strongly preferred
- 4+ years of related healthcare experience, including at least 1 year of leadership experience and preferably Medicare or health plan experience
- Knowledge of health plan systems (eg. Facets, JIVA); experience in Medicare Advantage, Appeals & Grievances, and/or other health plan operations preferred
- Good leadership skills with the ability to manage a team remotely, support a culture of accountability, ownership, and continuous learning, and promote subject matter expertise within the team by utilizing cross-training and team learning activities
- Good judgment, customer service skills, and personal and professional ethics
- Firm oral and written communication skills, problem-solving, interpersonal, logical, analytical, and critcal thinking skills with the ability to interact with individuals at all levels and personalities
- Effective investigatory skill with the ability to organize, analyze, and effectively determine risk and appropriate response; ability to remain objective and separate facts from opinions
- Ability to multi-task, delegate, prioritize work, operate effectively, and meet deadlines in a fast-paced environment with competing priorities in both remote and in-person settings
- Skilled at self-motivating and balancing working collaboratively and autonomously as required; ability to be energetic, persistent, and forward thinking
- Proficiency in Microsoft Office including Outlook, Word, Excel, Notebook and PowerPoint
- While performing the duties of this job, the employee works in normal office working conditions.
Disclaimer: The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands, and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.