Independence Blue Cross LLC
Manager of Appeals (Medicare) (Legal)
The Manager of Appeals manages the appeal processes to include intake/triage functions, investigations, resolutions, documentation, determinations, and follow-up activities for all case types according to all regulatory and accreditation standards, contractual arrangements, and benefit plans.
Trends appeal issues, implements revised department procedures, and recommends corporate policy and procedure changes to reduce the volume of cases and improve member satisfaction. Ensures timely, accurate and compliant processing for member and provider satisfaction, efficient corporate processes, and to avoid regulatory or accreditation penalties.
• Bachelor's degree or equivalent experience required. Five years of progressive related experience as an established professional in an appeals, claims, or service operations environment.• Medicare Advantage and STARs experience highly preferred