Supervisor Grievances amp Appeals

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

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 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

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

Demonstrated capability with coaching and developing associates formally and informally

Previous customer service experience

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

Ability to individually prioritize high-risk work

Previous experience working in the healthcare industry or medical field

Excellent written, verbal and electronic communication skills

Ability to partner with multiple cross-functional departments

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

Ability to commit to a Thursday-Monday shift with a focus on 8am - 4:30pm EST

Must ensure designated work area is free from distractions during work hours and virtual meetings

Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required

Preferred Qualifications

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

Results oriented; problem solver

Bilingual English/Spanish - must be able to speak, read and write in both languages without limitations or assistance

Scheduled Weekly Hours

40

Company info

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