Kforce has a client in Los Angeles, CA that is seeking an A&G Supervisor responsible for direct supervision and support of the team responsible for the intake, research, resolution, tracking, trending and reporting within the Appeals and Grievances department. This position will be accountable for leading and directing the work for the Appeals and Grievances department by monitoring the research, negotiation and resolution of all types of appeals and grievances to ensure thorough investigations are completed as outlined in the company policies and procedures.
Responsibilities:
Provides support and ownership of cases identified as escalated, complex and/or multi-issue appeals and grievances on an as needed basis
Collaborates with internal departments to ensure timely resolution
Analyzing and trending for all appeals and grievances
Responsible for the development and maintenance of the appeal and grievance Policies and Procedures, workflows, Member correspondence, and training as needed, or on an annual basis
Supervises all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports
Evaluate daily reports to ensure individual and team Key Performance Indicators (KPIs), SLAs, Performance Scorecards meet regulatory requirements
Provide direction to staff for complex/sensitive member and provider inquiries, concerns, complaints, appeals, and grievances; Conduct weekly 1:1s with direct reports
Build and maintain strong working relationships with internal departments involved in appeal and grievance resolution
REQUIREMENTS:
Bachelor's degree; In lieu of degree, equivalent education and/or experience may be considered; Master's degree preferred
3+ years of experience in a healthcare setting in Grievances and Appeals, Compliance, Claims or Call Center
2+ years of leading process, program, or staff or supervisory experience
Previous experience in Managed Health, preferably in Customer Service, Appeals and Grievances and/or Claims preferred
Ability to manage and organize large volumes of data
Knowledge of regulatory and accreditation entities and their requirements
Excellent verbal and written communication skills and interpersonal skills
Good working knowledge of licensure and regulatory requirements, and accreditation standards
Ability to work independently
Ability to solve complex issues and identify creative solutions
Computer ease and literacy with Microsoft Office (Word, Excel, Power Point, Access, and Visio)
Additional Information
This position requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical situations and work on-call
This position requires handling various caseloads and flexibility to adapt to changing priorities which may include but not limited to redistributed work assignments, team projects, and other priorities as assigned
The pay range is the lowest to highest compensation we reasonably in good faith believe we would pay at posting for this role. We may ultimately pay more or less than this range. Employee pay is based on factors like relevant education, qualifications, certifications, experience, skills, seniority, location, performance, union contract and business needs. This range may be modified in the future.
We offer comprehensive benefits including medical/dental/vision insurance, HSA, FSA, 401(k), and life, disability & ADD insurance to eligible employees. Salaried personnel receive paid time off. Hourly employees are not eligible for paid time off unless required by law. Hourly employees on a Service Contract Act project are eligible for paid sick leave.
Note: Pay is not considered compensation until it is earned, vested and determinable. The amount and availability of any compensation remains in Kforce's sole discretion unless
and until paid and may be modified in its discretion consistent with the law.
This job is not eligible for bonuses, incentives or commissions.
Kforce is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.
By clicking "Apply Today" you agree to receive calls, AI-generated calls, text messages or emails from Kforce and its affiliates, and service providers. Note that if you choose to communicate with Kforce via text messaging the frequency may vary, and message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You will always have the right to cease communicating via text by using key words such as STOP.
