Supervisor Grievance amp Appeals Bilingual English/Spanish Work at Home - FL

Profile

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

Associate's Degree

Fully Bilingual English/Spanish . Must be able to speak, read and write in both languages without limitations or assistance. If selected for the position, you will be required to take a Language Proficiency Assessment in English/Spanish. See Additional Information on testing

2 years of customer service experience

1 years of prior leadership 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

COVID VACCINATION : Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Work-At-Home 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

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

Schedule: Monday to Friday from 8 am to 5 pm, Overtime availability and as per business needs.

Training Virtual training 4 weeks of process training and 3 weeks of on the job training.

Work Location (Address): Work at Home (WAH): Associates work their entire work schedule from their Humana approved home location

Travel: 25% - occasional travel to mailing facilities (UPS/USPS)

Language Proficiency Testing (English/Spanish): Any Humana associate who speaks with a member in a language other than Spanish and/or English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.

Scheduled Weekly Hours

40

Company info

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