| Title: | Team Leader Advocacy Unit |
| Department: | Compliance |
| Operating Team: | Corporate Administration |
| Position Resides at: | Buffalo |
| Summary: | This position receives general direction from the Director of Advocacy and receives direction on medical and utilization management matters from the Medical Director. Provides supervision and coordination of the workload of the, member and provider Advocacy units which includes grievances, appeals, executive inquiries, regulatory complaints and external review requests. Conducts case work in addition to supervisory duties. Is alert to problems as they arise from subscribers, providers and groups. Makes recommendations for problem resolution. Available to other corporate areas as the central contact for handling claims questions, inquiries, and research requests. Assures timely response to subscriber and provider complaints, as required by law. |
| Qualifications: | Bachelor's Degree or equivalent in Business Administration, with a minimum of five years progressive experience in claims and/or customer service related areas. Must have complete knowledge of all claims processing systems, contracts, and riders. Must possess a thorough knowledge of current policies, procedures, and rules for all lines of business, plus federal and state activities as they relate to subscribers' rights. Must be able to effectively communicate with all levels in the corporation, as well as subscribers, providers, and government agencies. |
| Additional Information: | |
| FLSA Status: | Exempt |
| Tracking #: | B06-6541 |
| Position Control #: | |
Eligible for
Relocation: | No |
| Contact Information: | Mindi Fluri |
| Posting Date: | 11/10/06 |
