Supervisor Grievance amp Appeals- Work at Home FL

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Job Information
Humana
Supervisor, Grievance & Appeals- Work at Home FL
in
Aventura
Florida
Description
The Supervisor, Grievances & Appeals manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if an a grievance, appeal or further request is warranted and then delivers final determination based on trained skillsets and/or partnerships with clinical and other Humana parties. 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
The Supervisor, Grievances & Appeals assists members, via phone or face to face, further/support quality related goals.
Investigates and resolves member and practitioner issues.
Decisions are typically 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
Bilingual English/Spanish - must be able to speak, read and write in both languages without limitations or assistance
Bachelor's Degree
4 - 6 years of customer service experience
Minimum of 2 years prior supervisory experience
Experience working in a high volume production environment
Previous experience working in the healthcare industry or medical field
Excellent written, verbal and electronic communication skills
Advanced proficiency in Microsoft Office programs including Word, Excel, and Outlook
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
COVID Requirements
: For this job, associates are required to be fully COVID vaccinated, including booster or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
If progressed to offer, you will be required to:
Provide proof of full vaccination, including booster or commit to testing protocols
*OR  *
Provide proof of applicable exemption including any required supporting documentation
​​ Medical, religious, state and remote-only work exemptions are available.
Preferred Qualifications
Previous experience working in Grievance and Appeals
Beginner knowledge in Microsoft PowerPoint and Access
General understanding of healthcare economic, financial and operational concepts
Results oriented; problem solver
Additional Information
Hours:
Monday to Friday from 8 am to 5 pm, Overtime availability and as per business needs
Scheduled Weekly Hours
40

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