Senior Manager Complaints & Appeals - Community Health Choice
JOB SUMMARY: Senior Manager of Complaints and Appeals ensures the proper management of all provider and member complaints as they relate to Adverse Determinations. The Senior Manager ensures that all regulatory deadlines are met. The Senior Manager of Complaints and Appeals will also apprise the Director of Quality & Outcomes in Medical Affairs of trends in adverse determinations that are either provider specific or specific to severity or intensity of service delivery. The Senior Manager also acts as the lead Manager/trainer for the appeals team in the Medical Affairs Department. In this capacity, s/he will be responsible for orientation and training of new hires in the department as well as training for new products and product updates. The Senior Ma
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