Manager, Grievance/Appeals and Data Analytics
Welcome to Elevance Health, where we are committed to transforming the healthcare industry through innovative solutions and data-driven insights. We are seeking a highly skilled and motivated individual to join our team as the Manager of Grievance/Appeals and Data Analytics. This key role will be responsible for overseeing the grievance and appeals process, as well as utilizing data analytics to identify trends and drive decision-making. Our ideal candidate will have a strong background in healthcare, excellent analytical skills, and a passion for improving the healthcare experience for all. If you are looking for a challenging and rewarding opportunity to make a difference in the healthcare industry, this may be the perfect role for you.
- Oversee the entire grievance and appeals process to ensure timely and accurate resolution of member complaints and disputes.
- Develop and implement policies and procedures to streamline the grievance and appeals process and ensure compliance with regulatory requirements.
- Utilize data analytics to identify trends and patterns in member complaints and appeals, and provide recommendations for improvement.
- Collaborate with cross-functional teams to identify root causes of grievances and appeals and implement proactive solutions to prevent recurring issues.
- Maintain a high level of customer service and communication with members, providers, and internal stakeholders throughout the grievance and appeals process.
- Monitor and report on key performance indicators related to grievances and appeals, and make data-driven recommendations for improvement.
- Stay current on industry trends and regulatory changes related to grievances and appeals, and ensure compliance with all applicable laws and regulations.
- Manage a team of grievance and appeals specialists, providing guidance, coaching, and performance evaluations.
- Conduct trainings and presentations to educate internal teams and external stakeholders on the grievance and appeals process and best practices.
- Continuously evaluate and improve the efficiency and effectiveness of the grievance and appeals process to enhance the overall member experience.
Extensive Experience In Managing Grievance And Appeals Processes – The Ideal Candidate Should Have A Strong Understanding Of The Healthcare Industry And Be Well-Versed In Managing The Grievance And Appeals Process. This Includes Knowledge Of Regulations And Guidelines, As Well As Experience In Handling Complex Cases.
Proficiency In Data Analytics – As A Manager Of Grievance/Appeals And Data Analytics, The Candidate Must Have A Deep Understanding Of Data Analytics And Be Able To Use It To Drive Decision Making. This Includes The Ability To Analyze Large Amounts Of Data, Identify Trends And Patterns, And Present Actionable Insights To Senior Management.
Excellent Communication And Interpersonal Skills – Strong Communication And Interpersonal Skills Are Essential For This Role, As The Candidate Will Be Responsible For Managing A Team And Interacting With Various Stakeholders, Including Members, Providers, And Regulatory Bodies.
Leadership And Team Management Abilities – The Candidate Should Have Proven Leadership And Team Management Abilities, With A Track Record Of Successfully Managing And Motivating A Team To Achieve Goals And Objectives.
Knowledge Of Healthcare Regulations And Compliance – A Deep Understanding Of Healthcare Regulations, Including But Not Limited To Hipaa, Erisa, And Medicare/Medicaid, Is Crucial For This Role. The Candidate Should Also Have Experience In Ensuring Compliance With These Regulations And Be Able To Implement Processes To Mitigate Compliance Risks.
Data Analysis
Communication
Team Management
Negotiation
Leadership
Conflict Resolution
Analytical Thinking
Reporting
Problem-Solving
Stakeholder management
Policy Development
Decision-Making
Communication
Conflict Resolution
Emotional Intelligence
Leadership
Time management
creativity
Attention to detail
Teamwork
Adaptability
Problem-Solving
According to JobzMall, the average salary range for a Manager, Grievance/Appeals and Data Analytics in Las Vegas, NV, USA is between $83,000 and $126,000 per year. This can vary depending on the specific company, industry, and level of experience. Some factors that may affect the salary range include the size and profitability of the company, the candidate's level of education and certifications, and the demand for this type of role in the job market. It is important to research the specific company and industry when considering a salary for this position.
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Elevance Health, Inc. is an American health insurance provider. The company's services include medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans through affiliated companies such as Anthem Blue Cross and Blue Shield, Empire BlueCross BlueShield in New York State, Anthem Blue Cross in California,Wellpoint, and Carelon.It is the largest for-profit managed health care company in the Blue Cross Blue Shield Association. As of 2022, the company had 46.8 million members within their affiliated companies' health plans. Prior to June 2022, Elevance Health was named Anthem, Inc.
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