What are the responsibilities and job description for the Supervisor of Appeal Operations position at Cambia Health Solutions and Careers?
Supervisor of Appeal Operations
Work from home Within Oregon, Washington, Idaho or Utah
Build a career with purpose. Join our
Cause
to create a person-focused and economically sustainable health care system.
Who We Are Looking For:
Every day, Cambia's dedicated Supervisor Appeals Operations, are living our mission to make healthcare easier and lives better. As a member of the Appeal Operations team, our Supervisor Appeals Operations supervises the team and acts as a resource for Certified Professional Coders, and/or non-clinical support staff. Overseas and coordinates team activities to achieve business objectives and ensure the timely processing of member and provider claims and are in alignment with contract provisions, proper coding, policy or regulatory compliance across multiple lines of business, all in service of creating a person-focused health care experience.
Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.
What You Bring to Cambia:
Qualifications:
- 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
Skills and Attributes:
- 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)
What You Will Do at Cambia:
- 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.
#LI – Remote
The expected hiring range for a Supervisor of Appeal Operations is $76,500 - $103,500 salary depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 10%. The current full salary range for this role is $72,000 - $117,000.
About Cambia
Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100 year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.
Why Join the Cambia Team?
At Cambia, you can:
- Work alongside diverse teams building cutting-edge solutions to transform health care.
- Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
- Grow your career with a company committed to helping you succeed.
- Give back to your community by participating in Cambia-supported outreach programs.
- Connect with colleagues who share similar interests and backgrounds through our employee resource groups.
We believe a career at Cambia is more than just a paycheck – and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.
In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:
- 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.
Learn more about our
benefits
.
We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email
CambiaCareers@cambiahealth.com
. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy
.Salary : $72,000 - $117,000