SummaryThe
Appeals Supervisor is responsible for overseeing daily operations of appeals adjudication activities, ensuring timely, accurate provider response. This role provides direct leadership to appeals staff, serves as an operational liaison to clients and internal stakeholders, and drives performance through standard performance management, process improvement, and workforce coaching. The ideal candidate brings strong healthcare operations experience, proven people leadership, and the ability to manage performance in a client-facing, metric drive environment.
Your role in our mission- Oversee day-to-day provider appeal adjudication operations.
- Analyzes appeals and provides recommendations on how to reduce the number of provider appeals.
- Ensure adherence to standard operating procedures (SOPs), regulatory requirements, service level agreements (SLAs), and clint-specific performance standards.
- Lead, coach, and develop a team of Appeals Examiners, and Appeals support staff, supporting performance management and training.
- Monitor operational performance, including productivity, accuracy, turnaround times, and backlog levels, and implement action plans to drive improvement.
What we're looking for- 3-5+ years of experience in healthcare operations, claims/appeals processing, provider services, or Medicaid-related functions.
- 5+ years of supervisor or people leadership experience.
- Experience managing performance metrics, including KPIs, SLAs, productivity, and quality standards
- Strong analytical skills with the ability to interpret data, identify trends, and drive process improvements.
- Excellent communication and interpersonal skills with the ability to engage effectively in a client-facing environment.
- Ability to manage multiple priorities, meet deadlines, and operate effectively in a fast-paced, high-volume environment.
What you should expect in this role- Lead and develop a team of Appeals Examiners and support staff in a fast-paced, high-volume healthcare operations environment.
- Monitor and drive performance related to productivity, quality, turnaround times, service level agreements (SLAs), and operational goals.
- Collaborate with clients, providers, and internal stakeholders to resolve issues and ensure exceptional service delivery.
- Analyze operational data, identify trends, and implement process improvements to enhance efficiency and reduce provider appeals.
- Work on-site in West Sacramento, California, Monday through Friday from 7:00 AM to 4:00 PM, while supporting a culture of accountability, continuous improvement, and employee development.
*This posting is intended for pipelining. We will accept applications on an ongoing basis.#LI-ONSITE
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The pay range for this position is $78,000 - $111,400 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
