Hiring: Supervisor Appeals Company: Independence Blue Cross Location: Philadelphia, PA Job Posted Time: 2026-09-13 10:40:38 Target Skills & Keywords : Quality Assurance About the job Experience: •3 years of experience in customer service, health plan operations, appeals/grievances, or similar setting; OR in lieu of degree, 5 years of experience in an appeals role. •At least 3 years of experience in customer service, health plan operations, appeals/grievances, or similar setting; OR in lieu of degree, 5 years of experience in an appeals role. Required Skills: •Leadership & Expertise •Provides expertise, guidance, and technical support to the Administrative Appeals team to ensure compliance with NCQA and state requirements and organizational standards. •Educates staff on new or updated procedures, NCQA and state rule changes, and internal process improvements; monitors adoption of procedures to ensure consistency and accuracy. •Coaches, develops, and motivates staff to achieve performance expectations, maintain quality standards, and support regulatory adherence. •Appeals Operations Management •Oversees daily workflow of Appeals Specialists to ensure administrative appeals are appropriately categorized (standard vs. expedited; pre-service vs. post-service; Caritas external appeals) and processed within required timeframes. •Ensures timely and accurate execution of all appeal‑related activities, including intake, triage, case creation, tracking, letter generation, and documentation within business systems. •Provides initial research and guidance on specific appeal issues; applies administrative exception procedures consistently and in accordance with established guidelines. Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!