Appeal Resolution Manager manages the grievance process to review, investigate, document, process, negotiate, and resolve disputed medical, insurance, and other claims. Oversees work activity that is compliant with all regulatory guidelines and policy protocols. Being an Appeal Resolution Manager allocates team resources to ensure an effective and balanced case workload. Applies industry standards and uses best practices in the preparation of legal briefs. Additionally, Appeal Resolution Manager may represent the organization at hearings. Requires a bachelor's degree. Typically reports to a senior manager or head of a unit/department. The Appeal Resolution Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. To be an Appeal Resolution Manager typically requires 5 years experience in the related area as an individual contributor. 1 - 3 years supervisory experience may be required. Extensive knowledge of the function and department processes. (Copyright 2024 Salary.com)
The Opportunity What you'll do:
Directs staff and initiatives that support Risk and control management programs, to include governance support, Risk oversight, Risk infrastructure development, Risk identification, quantification, aggregation, and emerging Risks.
Advises senior management and influences process change.
Builds and leads a high performing team of Risk and internal control professionals through recruitment, training, coaching, performance management and related managerial activities.
Handles consulting relationships with internal and external clients regarding budget and implementation results and Risk mitigation plans as appropriate.
Partners with key collaborators in the business and is responsible for the identification, assessment and documentation of Risks and controls, including Risks associated with new or modified products, services, distribution channels, regulations and/or third-party operations.
Reviews, communicates and recommends the development of governance policies and procedures in partnership with senior leaders to ensure appropriateness and adequacy versus industry best practices and regulatory requirements.
Provides counsel to business unit managers on Risk management issues and supports the evaluation of new product strategies on their impact to USAA's Risk profile.
Educates Risk owners on Risk/control best practices and may work with other lines of defense in the development and implementation of controls.
Innovates processes for collecting accurate and complete internal loss data from business areas.
Directs analysis and data mining initiatives that identify, validate, and lead emerging Risk exposures, as necessary.
Assists in the early identification of Risk trends by establishing and monitoring key performance and Risk indicators.
Oversees the preparation of key reports and communications and may present to governance committees, senior leaders, regulatory bodies and the USAA Board of Directors.
Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.
What you have:
Bachelor's Degree in Risk Management, Business, Finance or related field of study; OR 4 years of Financial Fraud experience (in addition to the minimum years of experience required) may be substituted in lieu of degree
8 years of experience supporting Risk and/or compliance related activities in a financial services operating environment or other relevant industry; OR 8 years of experience in a relevant quantitative discipline; OR Advanced degree or designation in a Risk management or quantitative subject area, and 6 years of experience supporting Risk and/or compliance related activities; OR PhD in a Risk management or quantitative subject area, and 4 years of experience supporting Risk and/or compliance related activities.
3 years of direct team lead or people management experience.
Knowledge of federal laws, rules, regulations, and applicable guidance to include: OCC Heightened Standards, BSA/AML, REG E, REG CC, UDAAP/UDAP, TILA/REG Z, SCRA, FCRA, MLA.
What sets you apart:
Experience in Fraud at a Financial Institution
Strong influential written and verbal communication skills.
Expert knowledge of Microsoft Office
Issues Management experience
Working with Regulators
US military experience through military service or a military spouse/domestic partner
The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.
What we offer:
Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location. The salary range for this position is: $120,550-$230,400.
Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.
Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.
For more details on our outstanding benefits, please visit our benefits page on
Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting.
USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
About the Company:
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