About The Role

　　The Appeals Supervisor is responsible for supervising a staff of Appeal Coordinators while promoting quality and superior results. The Appeals Supervisor is accountable for identifying opportunities for enhancements and changes to workflows to increase effectiveness and productivity of the team.  Provides on-going assistance to the team to assist in resolving open appeal inquiries accurately and within the specified time frames.  Must be able to make independent decisions, prioritize workload effectively and collaborate with other internal departments to assist in meeting our corporate goals. 

　　This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.

　　Primary Responsibilities

　　•    Effectively supervise team members remotely.

　　•    Distribute daily work, monitor holding inventory, and ensure resolution of aged items.

　　•    Provide training to new hires and existing staff as needed.

　　•    Conduct research and provide solutions for escalated issues.

　　•    Collaborate with Medical Management leadership to ensure appeals workflows and processes support timely and               accurate responses.

　　•    Assist Customer Service in resolving customer questions and concerns.

　　•    Support the Client Services department by researching and resolving client inquiries.

　　•    Coach, counsel, and mentor employees to exceed quality, appeals accuracy, and productivity standards, removing             obstacles to meet goals.

　　•    Perform audits as needed.

　　•    Address and document performance and/or disciplinary issues.

　　•    Perform quarterly Performance Evaluations and consistently host individual and team meetings with team members.

　　Essential Qualifications

　　•    3+ years of experience in supervisory or leadership role. 

　　•    Proficient knowledge of Microsoft Word and Excel.

　　•    Working knowledge of appeals processing and associated ERISA guidelines and requirements.

　　•    Knowledge of contracts, medical terminology, and claims processing and procedures.

　　•    Appeal experience  

　　•    Excellent written and oral communication, interpersonal and negotiation skills with a demonstrated ability to prioritize        tasks as required.

　　•    Problem solving/analysis.

　　•    Organizational skills: ability to effectively prioritize and multitask.

　　•    Ability to establish and maintain positive and effective work relationships with clients, coworkers, members, providers       and customers.    

　　•    Enthusiastic attitude, cooperative team player, adaptable to new or changing circumstances.

　　•    Bachelor’s Degree preferred or comparable experience in the healthcare field.

　　About

　　At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion, and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all your unique abilities.

　　Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes, and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions.

　　Come be a part of the Brightest Ideas in Healthcare™.

　　Company Mission

　　Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.

　　Company Vision

　　Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.

　　DEI Purpose Statement  

　　At BHPS, we encourage all team members to bring your authentic selves to work with all your unique abilities.   We respect how you experience the world and welcome you to bring the fullness of your lived experience into the workplace.  We are building, nurturing, and embracing a culture focused on increasing diversity, inclusion and a sense of belonging at every level.

　　*We are an Equal Opportunity Employer

　　Annual Salary Range: $60,000-80,000

　　The salary range and/or hourly rate listed is a good faith determination that may be offered to a successful applicant for this position at the time of the posting of an advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable by law including but not limited to location, years of relevant experience, education, credentials, skills, budget and internal equity.

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