Disputes and Appeals Lead
Posted on Wednesday, November 15, 2023
About Lyra Health
Lyra is transforming mental health care through technology with a human touch to help people feel emotionally healthy at work and at home. We work with industry leaders, such as Morgan Stanley, Uber, Amgen, and other Fortune 500 companies, to improve access to effective, high-quality mental health care for their employees and their families. With our innovative digital care platform and global provider network, 10 million people can receive the best care and feel better, faster. Founded by David Ebersman, former CFO of Facebook and Genentech, Lyra has raised more than $900 million.
About the Role
Lyra Health is seeking a Dispute and Appeals Lead to lead and manage a newly established team responsible for processing EAP (Employee Assistance Program) claim appeals and resolving charge disputes. This position requires a strategic thinker who can build and optimize processes, oversee a team of processors, and ensure that appeals and disputes are handled efficiently and accurately. This individual will play a crucial role in improving workflows, driving operational excellence, and enhancing the overall effectiveness of the team.
- Manage Lyra’s charge dispute resolution program while driving improved efficiency and automation.
- Develop and implement standardized processes for handling EAP claim appeals.
- Collaborate with cross-functional teams to streamline operations, enhance the overall client experience and maintain compliance with industry standards and regulations.
- Collaborate with technical teams to identify, research, and resolve unexpected behavior within the platform.
- Continuously assess and refine manual and automated workflows to eliminate inefficiencies and bottlenecks.
- Create and maintain documented policies and procedures for internal and external audiences.
- Establish quality control measures to ensure the accuracy and consistency of appeal processing and dispute resolution.
- Develop and maintain reporting mechanisms to track team performance, productivity, and key performance indicators (KPIs).
- Analyze data and generate reports to provide insights for decision-making and process improvement.
- Handle complex or escalated cases, ensuring exceptional and empathetic service while resolving disputes and appeals.
- Identify training needs and provide ongoing development opportunities, coaching, and guidance for team members.
- 5+ years experience in appeals processing, dispute resolution, or related roles.
- 3+ years experience in people management.
- Experience in healthcare and/or medical billing is a plus.
- Experience with Salesforce and/or Zendesk.
- Proven experience in managing teams and building and optimizing processes.
- Strong understanding of EAP claims and charge dispute resolution preferred.
- Excellent leadership, coaching, and communication skills.
- Analytical mindset with a focus on continuous improvement.
- Planning, problem-solving and critical thinking skills to anticipate, avert, or resolve issues in staffing, scheduling and task allocation.
- Ability to flourish in a fast-paced, rapidly changing environment.
We are an Equal Opportunity Employer. We do not discriminate on the basis of race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information or any other category protected by law.
By applying for this position, your data will be processed as per Lyra Health Workforce Privacy Notice. Through this application, we will collect personal information from you including your name, email address, gender identity, employment information, and phone number for the purposes of recruiting and assessing suitability, aptitude, skills, qualifications, and interests for employment with Lyra. We may also collect information about your race, ethnicity, and sexual orientation, which is considered sensitive personal information under the California Privacy Rights Act (CPRA). Providing this information is optional and completely voluntary. If you are a California resident and would like to limit how we use this information, please use the Limit the Use of My Sensitive Personal Information form. This information will only be retained for as long as needed to fulfill the purposes for which it was collected, as described above. Please note that Lyra does not “sell” or “share” personal information as defined by the CPRA. For more information about how we use and retain your information, please see our Workforce Privacy Notice.