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)
Employee will be asked to deescalate customer complaints, leverage advantageous outcomes for the organization, and ensure quality control. Additional duties will be included as needed. Ability to lift 25 pounds required. Employee will need to stand for prolonged periods of time. Some travel required.
Negotiate deals for the Nakatomi corporation across all departments.
Handle customer complaints and requests.
Oversee quality control.
Bachelor's degree in Criminal Justice.
Experience in a high pressure environment.
Problem solving skills.
Critical thinking skills.
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