Supervisor Grievances amp Appeals - Louisville KY Waterside Green Bay WI or Cincinnati OH

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

Bachelor's Degree or equivalent work experience

2- 4 years of customer service experience

Minimum of a year 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

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

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

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

Additional Information

Work at Home/Remote Requirements

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 is required

Scheduled Weekly Hours

40

Company info

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