Mgr I Grievance/Appeals - 19306SY

WellPoint is the nation's leading health benefits company serving the needs of approximately 28 million medical members nationwide.



Responsible for management oversight of receipt, investigation and processing associated with member grievance and appeals. Essential duties to include, but are not limited to: overseeing the development, implementation and evaluation of programs as changes are made by Department of Managed Health Care (DMHC), California Department of Insurance (CDI), Congress, Centers of Medicare Medicaid Services (CMS), etc. Monitors, trends and analyzes grievance and appeals data for submission to appropriate parties. Serves as resource expert and mentor to unit and other departments for complex issues and interpretation of regulatory standards. May perform internal audits of grievance and appeals process. Ensures appeals and grievances are resolved within regulatory timeframes. Hires, trains, coaches, counsels and evaluates performance of direct reports. Performs other duties as assigned.



BA/BS or equivalent education and experience required.  3-5 years professional leadership experience required. Strong written, oral and interpersonal communication skills required. Strong analytical, tactical planning, organizational and managerial skills required. Strong PC skills required.  Current unrestricted RN license preferred.