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Job Details

Supervisor Grievances amp Appeals

Company name
Humana Inc.

Location
San Juan, PR, United States

Employment Type
Full-Time

Industry
Customer Service, Bilingual

Posted on
Apr 28, 2023

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Profile

Description

The Supervisor, Grievances & Appeals manages client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. The Supervisor, Grievances & Appeals works within thorough, prescribed guidelines and procedures; uses independent judgment requiring analysis of variable factors to solve basic problems; collaborates with management and top professionals/specialists in selection of methods, techniques, and analytical approach.

Responsibilities

Where you Come In

The Supervisor, Grievances & Appeals assists members to further support quality related goals. Investigates and resolves member and practitioner issues. Decisions are typically are related to schedule, plans and daily operations. Performs escalated or more complex work of a similar nature, and supervises a group of typically support and technical associates; coordinates and provides day-to-day oversight to associates. Ensures consistency in execution across team. Holds team members accountable for following established policies.

Required Qualifications - What it takes to Succeed

Grievance and Appeals (G&A) has an impact to our business and because of the complexities of our work, there is an 18-month commitment to this department. G&A will not allow transitions outside of area prior to the end of the 18-months

Minimum 2 years of previous experience with coordinating and leading projects and tasks

Demonstrated capability with coaching and developing associates formally and informally

Experience managing in a high volume production environment with time sensitive parameters

Previous experience working in the healthcare industry or medical field

Intermediate knowledge of Microsoft Office programs including Word, Excel, and Outlook

Previous customer service experience

Ability to individually prioritize high-risk work

Excellent written, verbal and electronic communication skills

Ability to partner with multiple cross-functional departments

Ability to commit to a Tuesday - Saturday shift with a focus on flexing between 10:30am - 7:00pm EST - Weekend support will be required on a rotational basis - Possible need to work Holidays

This is a Work from home position that will require possibility of travel up to 10%

Preferred Qualifications

High School Diploma, GED or job related certification

Associate's or Bachelor's Degree

Prior leadership experience

Working knowledge of GCP, CAS

Previous experience working in Grievance and Appeals

Ability to create professional Microsoft PowerPoint presentations

General understanding of healthcare economic, financial and operational concepts

Bilingual English/Spanish

Work-At-Home Requirements

WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

Satellite and Wireless Internet service is NOT allowed for this role.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Company info

Humana Inc.
Website : http://www.humana.com

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