Supervisor, Appeals
Location: Baton Rouge, Louisiana
Description: Blue Cross Blue Shield of Louisiana is employing Supervisor, Appeals right now, this job will be designated in Louisiana. Detailed specification about this job opportunity please give attention to these descriptions.
We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.
You should know that:
- Jobs are updated and posted daily.
- You must submit your resume online.
- Apply for each position for which you are qualified and interested in.
- You will only be considered for positions for which you apply.
- Resumes are only accepted for posted positions.
- Positions are full-time unless otherwise stated.
- Due to the high volume of applicants, only those most qualified will be contacted.
- We are unable to accept phone calls.
POSITION PURPOSE :
Oversees the daily operations of the unit for assigned staff in the unit.
Serves as a leader and back-up for assigned staff in the unit.
Directs and coordinates workload and ensures complex cases that require special expertise in the unit are resolved in a timely manner.
Complies with all laws and regulations associated with duties and responsibilities.
NATURE AN D SCOPE :
This position reports to Director, Regulatory Appeals.
ACTIVITIES OF DIRECT REPORTS:
This position has 7-9 direct reports.
NECESSARY CONTACTS:
In order to effectively fulfill this position, this position must be in contact with:
Various internal and external entities including, but not limited to, all levels of BCBSLA personnel, attorneys, group leaders, members, hospitals, physician offices, and DOI.
QUALIFICATIONS :
High school diploma or equivalent is required. Bachelor’s degree in related field is preferred.
Must have at least 5 years insurance experience to include experience in appeals and grievances or related field, adjustments and customer service and one year of demonstrated leadership experience. Experience can run concurrently.
Must be able to read and interpret benefits for all lines of business.
Must be able to read and interpret all p rovider contracts and manuals.
Must be knowledgeable and able to provide technical guidance on claims processing and complex appeals functions and cases.
Demonstrated knowledge of accreditation guidelines, state and federal laws, and relevant PC software including Legacy, Facets, MS Word, Excel and Outlook is required.
Requires attention to detail and excellent record-keeping skills. Must demonstrate the ability to work in a rapidly paced and ever-changing environment.
Able to make decisions, prioritize, find solutions and work independently.
Strong analytical and organizational ability and verbal and written communication skills are required.
Must have excellent time-management and effective interpersonal skills to respond to numerous inquiries in a diplomatic and timely manner.
Presentation and public speaking skills are required.
ACCOUNTABILITIES :
Administers all HR functions, including but not limited to, hiring, terminating, conducting performance reviews, setting performance standards, approving work schedules, assigning and directing workload, training and developing staff, coaching, etc. to ensure team goals are met.
Serves as the subject matter expert to ensure accurate and timely handling of cases. Maintains thorough knowledge of all contract types, required lines of business, changes to recent laws and regulations, computer systems and claims policies and procedures to ensure consistency in processes and responses.
Motivates, coaches, audits and trains staff by answering questions, providing technical assistance, reviewing case files and letters to ensure deadlines are met and compliance with company policy and laws and regulations are maintained.
Schedules and serves as presenter for 2nd level committee meetings, reviews and assembles 2nd level packets prior to meetings, and creates 2nd level spreadsheets and minutes for 2nd level meet ings.
Researches and responds to special inquiries from attorneys and upper management within the Legal Department .
Identifies and reports weekly trends in production, inventory levels, and performance statistics.
May be expected to interface with providers to promote education, consistency and satisfaction.
Coordinates the daily workflow to ensure compliance with established internal and external policies and procedures to ensure timeframes are satisfied.
Assists in the development of departmental policies and procedures. Makes complex decisions involving consumer and provider contracts or member benefits to ensure compliance with state and federal regulations, accreditation and business practices.
May be expected to be familiar with the many differences in the Self Funded block of business and our fiduciary responsibility and requirements.
Understands departmental goals and objectives and delivers work products to contribut e to these goals.
An Equal Opportunity Employer
All BCBSLA EMPLOYEES please apply through Workday Careers.
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If you were eligible to this job, please email us your resume, with salary requirements and a resume to Blue Cross Blue Shield of Louisiana.
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This job will be started on: Tue, 01 May 2018 20:33:01 GMT