UST HealthProof is a dynamic company with a mission to lower the cost of care and deliver the future of healthcare. Our consumer-centric approach gives our health plan customers a modern infrastructure and reduced administrative costs, helping to drive better business results for our customers — and better outcomes for our communities.
We achieve this mission together through teamwork, communication, collaboration, and focus. Our employees are our greatest assets, and we invite you to apply to be a part of our journey toward making a difference in healthcare in the United States.
You Are:
UST HealthProof is searching for a Supervisor for Appeals who will be accountable for processing and reporting all grievances and appeals to the highest quality possible and for ensuring that grievances and appeals are resolved timely and within all regulatory frameworks. This position ensures that all decisions made are accurate and complete and is responsible for developing and reporting all trends for management reporting. Additionally, this role ensures that all Grievance and Appeals policies and procedures are compliant with CMS requirements.
The Opportunity:
- Develop and implement effective strategies that enable the department to maintain efficient and cost-effective processes.
- Establish operational vision and obtain approval from senior management relative to grievances and appeals.
- Establish and maintain Grievance and Appeals processes and systems to ensure data quality to support UST HealthProof’s quality, production, and financial goals.
- Drive operational excellence into all processes and departmental interactions based on CMS and UST HealthProof’s requirements.
- Lead employees and other management in developing effective intercompany workflows for the Grievance and Appeals processes.
- Lead, coach, develop, and implement training programs to ensure staff competence.
- Operate a departmental audit/oversight program that focuses on continuous quality improvement.
- Establish regular reporting to ensure senior management is aware of Grievance and Appeals trends.
- Establish a positive working environment that promotes collaboration, transparency, and employee engagement.
- Identify innovative methods to improve performance and provider/customer satisfaction.
- Instill quality commitment value in the Grievance and Appeals team.
- Lead standards and processes for ensuring quality selection and retention of department employees.
- As the Appeals Supervisor at UST HealthProof, this is your opportunity to:
- Responsible for balancing workload to optimize the effectiveness of the department.
- Directly supervises exempt and non-exempt staff in accordance with company policies and applicable Federal and State Laws.
- Responsibilities include, but are not limited to, effectively interviewing, hiring, terminating, and training employees; planning, assigning, and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; and supporting and encouraging the engagement process.
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.
What you need:
- Bachelor’s degree in a related field. A relevant combination of education and experience may be considered in lieu of a degree.
- Three to five years’ experience of progressive responsibility in an insurance or managed care environment.
- One year of supervisory or lead experience in insurance or managed care is required.
- Experience in Grievance and Appeals or Customer Service in a managed care or insurance environment is preferred.
- Bilingual skills preferred.
- Proven problem-solving skills and ability to translate knowledge to corporate departments.
- Knowledge of the Grievance and Appeals regulations per CMS.
- Ability to establish training programs and motivate employees in a quality-minded environment.
- Strong leadership skills with the ability to mentor staff and develop teams.
- Ability to work with and empower others on a collaborative basis to ensure the success of the unit team.
- Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions, and employing active listening techniques.
- Ability to effectively present budgetary and/or cost information and respond to questions as appropriate.
- Ability to establish workflows, manage multiple projects, and meet necessary deadlines.
Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. As required by local law, UST HealthProof provides a reasonable range of compensation for roles that may be hired in California, Colorado, New York or Washington as set forth below.
Role Location: Remote
Compensation Range: $51,000-$77,000
Our full-time, regular associates are eligible for 401K matching, and vacation accrual and are covered from day 1 for paid sick time, healthcare, dental, vision, life, and disability insurance benefits. Depending on the role, some associates may also be eligible for stock options.
What we believe:
We’re proud to embrace the same values that have shaped UST HealthProof since the beginning. Since day one, we’ve been building enduring relationships and a culture of integrity. And today, it’s those same values that are inspiring us to encourage innovation from everyone, to champion diversity and inclusion, and to place people at the center of everything we do.