Supervisor Grievances amp Appeals Bilingual English/Spanish Doral FL

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 oversees all appeals submitted by members and providers and ensures appeals are worked timely and appropriately. 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


2-3 years prior Grievance and Appeal or Utilization Management Experience
Minimum of 1 year prior supervisory/leadership experience
Experience working in a high volume production environment
Excellent written, verbal and electronic communication skills
Strong sense of urgency and results oriented; problem solver
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.
Work At Home (WAH) - Temporary Due to COVID-19 emergency. Please note this permanent position allows you to work at home indefinitely until further notice. See additional information in section below.


Preferred Qualifications


Bachelor's Degree
Previous experience working appeals


Additional Information


Schedule: Monday to Friday from 8 am to 5 pm. Occasional overtime by business need
Training: 1 month in office - Remotely due to Covid-19
Work Location (Address): This permanent job is working from Home temporary due to Covid 19 emergency. This position will deploy to the following location at a future date: 11430 NW 20th Street, Suite 300 Doral, FL 33172 Travel:5%
# of Direct Reports: 15
Language Proficiency Testing : 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.
WAH requirements : Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information


Scheduled Weekly Hours

40

Company info

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