Cambia Health Solutions

Supervisor – Appeal Operations

Cambia Health Solutions

full-time

Posted on:

Location Type: Remote

Location: Idaho • Oregon • United States

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Salary

💰 $76,500 - $103,500 per year

About the role

  • Assigns and prioritizes work, sets goals, and coordinates daily activities of the team.
  • Provides regular updates and communication to staff through 1:1 and team meetings.
  • Monitors individual and team results to ensure work is completed in a timely manner, in accordance with department standards and procedures, and in compliance with medical policy and medical necessity guidelines.
  • Assists in development of productivity and quality standards.
  • Conducts or participates in compliance audits, reports audit findings, and identifies and implements process improvements as needed.
  • Acts as a resource for staff and others.
  • Appropriately escalates issues, partners with other departments to resolve issues and remove barriers and collaborates with physician advisors on complex cases.
  • Participates in the hiring process and provides ongoing coaching, employee development, and performance reviews.
  • Develops and maintains desk reference guides on work procedures, ensures new hires complete necessary training, and assesses training needs while playing an active role in staff development.
  • Completes special projects as assigned and provides back-up support to staff as needed.
  • May develop and present educational updates internally or to other departments.
  • Seeks ideas and opportunities for continuous improvement, determines which opportunities should be pursued, and implements improvements as appropriate.

Requirements

  • Bachelor's degree in healthcare or related field
  • 3 years of leadership experience in the health insurance industry
  • 5 years of claims review, customer service, or membership experience
  • Equivalent combination of education and experience considered
  • Coding experience strongly preferred
  • Supervises 8-12 FTEs
  • Demonstrated competency in setting priorities for a team and overseeing work outputs and timelines
  • Ability to communicate effectively, both verbally and in writing
  • Ability to effectively develop and lead a team, including employees in multiple locations or working remotely
  • Demonstrated experience in recognizing problems and effectively resolving complex issues
  • Familiarity with health insurance industry trends and technology
  • Knowledge of medical terminology and payment coding guidelines, as applicable
  • Experience with AI tools and technologies to enhance productivity and decision-making in professional settings (highly desired).
Benefits
  • Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
  • Annual employer contribution to a health savings account.
  • Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
  • Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
  • Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
  • Award-winning wellness programs that reward you for participation.
  • Employee Assistance Fund for those in need.
  • Commute and parking benefits.
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
coding experienceclaims reviewcustomer servicemembership experiencemedical terminologypayment coding guidelinescompliance auditsprocess improvementsproductivity standardsquality standards
Soft Skills
leadershipcommunicationteam developmentproblem-solvingprioritizationcoachingemployee developmentperformance reviewscollaborationcontinuous improvement