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Kaiser Permanente Careers

Customer Service

Making Each Interaction Extraordinary

Functioning as a liaison between our members, employer groups, providers, brokers, and internal customers, our customer service groups are the face and voice of Kaiser Permanente. They play a vital role in explaining our offerings, policies, and procedures as well as meeting the needs of our members across the country.

Appeals and Correspondence Supervisor

Location: Rockville, MD Additional Locations:
Job Number: 778131 Date posted: 03/18/2019
Description:

Responsible for the day-to-day work flow, work product quality and supervision of employees engaged in responding to member and provider correspondence and inquiries from regulatory agencies and resolving member and provider requests for appeals. Ensuring adequate documentation and timeliness of Member Appeal Packets presented to the Appeals Committee. Responsible for meeting all regulatory and accrediting agency requirements regarding documentation, timeliness and application of rules and procedures, including National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), Maryland Health Choice Program, State of Virginia Medicaid, State and Federal laws and regulations and Kaiser Permanente Health Plan policies and procedures.


Essential Responsibilities:

  • Responsible for the day-to-day supervision of the Appeals and Correspondence staff to include training, monitoring of compliance and quality, establishing individual and team performance measures, recruiting, hiring/terminating, conducting performance reviews, establishing goals, rewards, and recognition.

  • Establishes and maintains effective communication with subordinate staff through regular staff meetings with the group to share information, and one-to-one interactions with individuals to discuss and review cases.

  • Serves as a member of the Appeals and Correspondence management team providing direction about cases, accountability for tracking and monitoring caseload and ensuring implementation of processes and procedures of outcomes.

  • Identifies operational deficiencies, staffing and other resource issues; implements corrective actions identified.

  • Develops, implements, and updates detailed procedures for the appeals process and correspondence with members; researches new or unusual issues and develops accurate and consistent responses to members and regulators.

  • Researches and responds to procedural and policy questions for regional and national complaints. Manages regulatory inquires, including but not limited to review of response letters after these responses are completed by appeals and resolution staff.

  • Participates in facilitating the activities of the Appeals Committee; participates in quarterly appeals meeting of committee members to address trends and or systemic issues identified during the appeals process.

  • Ensures all materials are present, organized and complete for all external and internal audits and reviews.

  • Other duties and projects as assigned.

  • Basic Qualifications:

    Experience

  • Minimum five (5) years of work experience in health care, customer service, or a related field required.

  • Minimum two (2) years of work experience in a supervisory or lead role required.

  • Minimum two (2) years of experience with regulatory and compliance requirements required.

  • Education

  • Bachelor's degree in health care or a related field OR four (4) years of experience in a directly related field.

  • High School Diploma or General Education Development (GED) required.

  • License, Certification, Registration

  • N/A

  •  


    Additional Requirements:



  • Strong critical thinking, analytical, negotiation, presentation, investigative and problem solving skills.

  • Knowledge of medical terminology or HMO policy and procedures.

  • Intermediate to high proficiency in basic software and system applications (e.g. MS Word, Excel, and PowerPoint).

  • Strong working knowledge of federal and state laws and regulations related to health care and managed care organizations.

  • Excellent interpersonal, verbal and written communication skills.

  • Proven excellent customer service and service recovery skills for members and providers.

  • Demonstrated conflict resolution and mediation skills with ability to secure action from persons outside their supervision.

  • Ability to use sound judgment and to handle potentially charged issues independently but with the knowledge and ability to escalate and ask for help when needed.

  • Ability to multitask and manage time in order to perform well on long-term projects while being flexible enough to assimilate short term projects on an ongoing basis.

  • Must be able to work in a Labor/Management Partnership environment.


  • Preferred Qualifications:

  • Knowledge of Kaiser Permanente MAS member service functions, policies, procedures, and practices are preferred.
  • Primary Location: Maryland,Rockville,Rockville Regional Offices 2101 E. Jefferson St. Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 8:30 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level: Team Leader/Supervisor Job Category: Customer Services Department: Appeals and Correspondence Travel: No Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

    External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

    About Customer Service Careers

    Customer Service Careers

    With over 11 million members, more than 127,000 employees, and over 40 million doctor visits a year, our customer service teams need you to come work with a wide variety of people to address concerns, resolve grievances, and educate our communities about our offerings. At Kaiser Permanente, you'll put your communication and mediation skills to work in support of excellence. We are committed to supporting you with ongoing growth, training, and development opportunities.

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