Supervisor Grievances amp Appeals

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Job Information
Humana
Supervisor, Grievances & Appeals
in
Jacksonville
Florida
Description
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
Bachelor's degree in related field or equivalent experience.
Previous experience in a leadership position such as: Supervisor, SME, Trainer, or Preceptor.
Experience working in a high volume, fast paced production environment.
Minimum 2 years' experience working in the healthcare industry or medical field.
Excellent written, verbal and electronic communication skills
Results oriented, problem solver.
Advanced proficiency in Microsoft Office programs including Word, Excel, and Outlook
Bilingual English/Spanish - must be able to speak, read and write in both languages without limitations or assistance.
Preferr
ed Qualifications
Previous experience working in Grievance and Appeals
Knowledge in Microsoft PowerPoint and Access
Additional Information
Any Humana associate who speaks with a member in a language other than 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.
Humana Perks:
Full time associates enjoy:  
Medical, Dental, Vision and a variety of other supplemental insurances  
Paid time off (PTO) & Paid Holidays 
401(k) retirement savings plan
Tuition reimbursement and/or scholarships for qualifying dependent children.
And much more! 
Social Security Task:
Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from **** with instructions to add the information into the application at Humana's secure website.
Virtual Pre-Screen:
As part of our hiring process for this opportunity, we will be using exciting virtual pre-screen technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a virtual pre-screen, you will receive an email and text correspondence inviting you to participate in a Modern Hire interview. In this virtual pre-screen, you will receive a set of questions to answer. You should anticipate this virtual pre-screen to take about 10-15 minutes.
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.
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 ****

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