Appeals & Claims Operations Administrator
$80,000–$110,000 year
On-site · Washington, District of Columbia, United States
Job Summary
Oversee and coordinate end-to-end appeals and claims workflow across health-plan programs, supervising staff to ensure timely, accurate, and compliant review of clinical, legal, and administrative appeals; implement standardized procedures, monitor queues and performance, and prepare regular reports on volumes, timeliness, and quality. Role includes onboarding/training, audits, and driving process improvements in alignment with federal/state regulations and client policies; collaborates with leadership and client contacts to meet SLAs and address operational issues across multiple product lines including marketplace/Exchange eligibility and grievances.
Required Qualifications
- Bachelor’s degree preferred; an Associate degree with strong relevant experience will be considered
- Experience supervising or coordinating teams and workflows
- Familiarity with Medicaid, CMS, and/or marketplace/Exchange regulations is preferred
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