Senior Manager, Appeals and Document Management

The Manager, Appeals and Document Management is responsible for the end-to-end operation of two closely linked functions: the Appeals team, which manages the appeals process from intake through resolution — validating eligibility, routing each appeal to the appropriate reviewer, and generating and sending acknowledgement and determination correspondence once a decision is made, and the Document Management team, which handles incoming mail, fax, and email intake, DocuWare indexing, and related administrative processing. This role ensures appeals are processed and responded to within required timeframes, that incoming correspondence is captured, routed, and indexed accurately and promptly, and that both teams operate as a well-coordinated intake-to-resolution pipeline.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Oversee the Appeals team's review and determination of member and provider appeals, ensuring compliance with required timeframes (including acknowledgement, determination, and expedited/urgent appeal windows).
• Maintain oversight of the Appeal Tracker, including category assignment, routing logic, and reporting used to monitor caseload and aging.
• Serve as escalation point for appeal determinations, provider payment disputes, and coordination with Contracting, Care Management, Claims, and external payer partners (e.g., Cigna, BXAZ).
• Coordinate the Appeal Committee process for appeals requiring committee-level review.
• Ensure accurate distinction between formal appeals, grievances, and provider payment disputes (underpayment, provider reconsideration, overpayment) at intake and throughout processing.
• Oversee intake and processing of incoming mail, fax, and correspondence email, and DocuWare indexing/e-filing across preauthorization, claims, appeals, and related trays.
• Ensure Document Management staff correctly identify and route items to the appropriate downstream owner.
• Monitor daily volume and productivity across fax, mail, and indexing trays, and adjust staff assignments to address volume spikes (e.g., fax volume surges) or backlog.
• Maintain the Document Management team's schedule and in-office coverage plan, including cross-training staff to cover multiple trays/functions.
• Directly supervise Appeals and Document Management staff, including hiring, onboarding, performance management, and professional development.
• Establish clear productivity expectations for both teams.

QUALIFICATIONS

• Experience in health plan operations, with direct experience in appeals, claims, or correspondence/document processing; prior people-management experience required.
• Working knowledge of regulatory appeal requirements and self-funded health plan operations preferred.
• Experience with DocuWare or comparable e-filing/indexing systems, Salesforce, and appeal-tracking systems (e.g., Power Apps-based tracker) preferred.
• Demonstrated ability to manage cross-functional workflows and coordinate across multiple internal teams and external payer partners.
• Strong written and verbal communication skills, including experience drafting or overseeing member- and provider-facing correspondence.
• Demonstrated discretion with confidential and Protected Health Information; completion of MotivHealth's HIPAA privacy and security training required

HOW WE SUPPORT YOU:

• 5% annual bonus based on company profitability
• Affordable health, vision, and dental insurance for you and your family
• Company contributes up to $2,300 to Health Savings Account annually
• Wellness program that contributes additional money towards your HSA
• Automatic 3% contribution into retirement plan
• Career development and growth opportunities
• Flexible Time Off & 10 paid holidays per year

MotivHealth is a dynamic and mission-driven health insurance company dedicated to disrupting the status quo by making healthcare simpler and more affordable for our members. We believe in empowering our members to take control of their health and financial well-being. Our innovative approach requires a team of passionate, talented individuals who aren't afraid to challenge conventional thinking and build solutions that truly make a difference. If you're looking to contribute your skills to a company that values innovation and positive impact, MotivHealth is the place for you.