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Team Lead, Grievance & Appeals at CareSource - ApplyBlast

Team Lead, Grievance & Appeals

CareSource

4 months ago

3.5 on Glassdoor

Onsite

Full Time

Senior

0 applicants

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About this role

The Team Lead, Grievance and Appeals oversees the operational performance of specialists handling Medicaid and Medicare appeals, ensuring strict adherence to regulatory and HIPAA compliance. The role involves managing staff, establishing audit processes, identifying operational trends, and facilitating the timely resolution of member and provider issues.

Responsibilities

Supervise grievance and appeals specialists for quality and performance metrics
Establish and monitor audit processes to ensure regulatory compliance
Identify irregular trends in grievances to root cause problems
Develop and enforce departmental policies and standard workflows
Coordinate with regulatory bodies and internal stakeholders for issue resolution

Skills

Qualifications

Associates Degree

About CareSource

caresource.com

Headquarters

Dayton, Ohio, United States

Company Size

1001-5000 employees

Founded

1989

View Profile

CareSource is a nonprofit managed care organization that provides health insurance plans and related healthcare services, primarily through Medicaid, Medicare, and Marketplace offerings. The company works with members, providers, and government partners to deliver access to medical, behavioral health, and care management services in the health insurance industry.