• Appeals Manager

    Job Locations US | US-CT-Wethersfield | US-TX-The Woodlands | US-CO-Westminster | US-FL-Orlando
    Posted Date 2 weeks ago(2 weeks ago)
    Job ID
    2018-1433
    # of Openings
    1
    Category
    Other
  • Overview

     

    The Senior Manager of Appeals leads a team responsible for the intake and resolution of all client employee appeals for all absence plans managed by ReedGroup. This senior manager oversees all aspects of the appeals process in accordance with State and Federal regulatory guidelines, ensuring adherence to established standards for quality and ensuring compliance with all applicable standards and regulatory, contractual and corporate policies and procedures. As the primary accountable operations leader for appeals, the Senior Manager develops operational metrics to measure individual and departmental performance.

    Who We Are: ReedGroup, headquartered in Westminster, CO, is a dynamic, fast growing organization that employs nearly 2,000 people at 11 locations globally. We are the top provider in the Absence Management industry and provide our services to major companies including a substantial number of Fortune 100 companies.  We are committed to improving health and productivity outcomes while controlling costs - it is at the core of our comprehensive solutions which are designed to return people to their active lifestyles and allow businesses to thrive.  

     

    Our Vision: Healthy and Productive People. Thriving Businesses. 

     

    Our Mission: ReedGroup connects the ecosystem of the health, work and life with …

    • The best service experience for clients and employees.
    • Trusted content and experience.
    • Strong partnerships across healthcare and insurance.
    • Innovative technology to drive simplicity.
    • Comprehensive data to create meaningful insights.

    Responsibilities

    ESSENTIAL FUNCTIONS:

    • Ensure alignment between the goals of appeals and the company’s strategic business and operations goals
    • Oversee team of appeals team members to achieve their highest potential productivity
    • Ensure that the department processes all appeals in accordance with referred time frames and other contractual legal and regulatory requirements
    • Monitor appeals and grievances and provide senior management with monthly reporting on trends
    • Integrate federal and state law changes into company’s regulatory system related to appeals
    • Recommend solutions and works with department and company staff to ensure problems are corrected and departments are advised of corrective measures to prevent recurrences
    • Provide training, coaching and direction to agencies in developing procedures to comply with appeals requirements
    • Work with service leaders to build action plans to address identified trends and issues
    • Develop and strengthen relationships with key vendors that support appeals. Gain efficiencies where possible through vendor capabilities.
    • Ensure the expedient handling of concerns and escalations from clients and their employees
    • Develops methods and mechanisms for presenting key appeals metrics, including creation of data-based insights and easily consumable dashboards
    • Hold weekly staff meetings, disseminates company information to staff, and lead team
    • Responsible for forecasting staffing needs, recommending efficiency strategies and management of the auditing staff
    • Attends department meetings and company meetings.
    • Other duties as required     

    Qualifications

    QUALIFICATIONS:

    • Bachelor’s Degree in Business Administration, Operations or related field; or equivalent combination of education achievement and business experience
    • 5-7 years of increasingly responsible experience leading shared service(s) within operations
    • Prior recent experience directly leading an appeals function within an insurance or benefits management organization highly desired; recent experience with absence management and/or disability management a plus
    • Strong communication skills (one-on-one, writing/editing skills, presentation skills)
    • Highly articulate with a polished professional presence
    • Excellent written, oral and presentation skills, as well as strong technological skills.
    • Operates in a way that never compromises ethics and integrity, non-political in all dealings with agendas that are above board and understood by all
    • Comfortable working in a high-energy, quickly changing and demanding environment
    • Demonstrated success in driving projects from initiation to completion
    • Demonstrated success managing shifting priorities with limited resources
    • Experience with Microsoft Office, Advanced Excel, Word, PowerPoint, Outlook
    • Experience with Project Management and Workflow Tools, such as MS project, Visio (preferred)
    • Experience with Collaboration Tools such as Skype, WebEx, SharePoint, etc.

    ReedGroup is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability, protected veteran status or any other status protected by applicable law.

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