Assigns and prioritizes work, sets goals, and coordinates daily activities of the team.
Provides regular updates and communication to staff through 1:1 and team meetings.
Monitors individual and team results to ensure work is completed in a timely manner, in accordance with department standards and procedures, and in compliance with medical policy and medical necessity guidelines.
Assists in development of productivity and quality standards.
Conducts or participates in compliance audits, reports audit findings, and identifies and implements process improvements as needed.
Acts as a resource for staff and others.
Appropriately escalates issues, partners with other departments to resolve issues and remove barriers and collaborates with physician advisors on complex cases.
Participates in the hiring process and provides ongoing coaching, employee development, and performance reviews.
Develops and maintains desk reference guides on work procedures, ensures new hires complete necessary training, and assesses training needs while playing an active role in staff development.
Completes special projects as assigned and provides back-up support to staff as needed.
May develop and present educational updates internally or to other departments.
Seeks ideas and opportunities for continuous improvement, determines which opportunities should be pursued, and implements improvements as appropriate.

Bachelor's degree in healthcare or related field
3 years of leadership experience in the health insurance industry
5 years of claims review, customer service, or membership experience
Equivalent combination of education and experience considered
Coding experience strongly preferred
Supervises 8-12 FTEs
Demonstrated competency in setting priorities for a team and overseeing work outputs and timelines
Ability to communicate effectively, both verbally and in writing
Ability to effectively develop and lead a team, including employees in multiple locations or working remotely
Demonstrated experience in recognizing problems and effectively resolving complex issues
Familiarity with health insurance industry trends and technology
Knowledge of medical terminology and payment coding guidelines, as applicable
Experience with AI tools and technologies to enhance productivity and decision-making in professional settings (highly desired).

Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
Annual employer contribution to a health savings account.
Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
Award-winning wellness programs that reward you for participation.
Employee Assistance Fund for those in need.
Commute and parking benefits.

Supervisor – Appeal Operations

Key skills