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Average Salary
Updated: 06/19/2013
Appeals Manager:
Manages the formal appeals process to ensure the resolution of grievances and appeals consistent with regulatory guidelines and organizational policies and procedures. Prepares formal hearing briefs and may appear at hearings on behalf of the organization. Ensures that appeals and... [+] More
Appeals Manager:
Manages the formal appeals process to ensure the resolution of grievances and appeals consistent with regulatory guidelines and organizational policies and procedures. Prepares formal hearing briefs and may appear at hearings on behalf of the organization. Ensures that appeals and grievances are entered into the database, categorized and processed within required timeframes.
Manages the formal appeals process to ensure the resolution of grievances and appeals consistent with regulatory guidelines and organizational policies and procedures. Hires, develops and motivates the appeals staff and oversees case load assignments/priorities. Prepares formal hearing briefs and may appear at hearings on behalf of the organization. Plans, organizes, implements and evaluates outcomes of the department’s strategic plans. Prepares and manages the departmental budget. Ensures that appeals and grievances are entered into the database, categorized and processed within required timeframes. Receives investigation results and responds to member appeals and grievances. Identifies quality issues. Analyzes reports and develops operating policies and procedures. This position typically requires a college degree in health sciences and related managed care experience. (Source: eDOT Job Description) [-] Less
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