Director Grievances amp Appeals

Profile

Description

The Resolution team handles all complaints for Humana, including formal grievances, appeals and inquiries that go to our executives. Our mission is to resolve these complaints quickly, effectively and with empathy. Additionally, we help Humana learn from customer complaints to continuously improve upstream processes and ultimately reduce the number of complaints we receive. We are currently in the midst of a people, process and technology transformation that will improve quality, timeliness and the overall experience for our associates, members and providers.

As the Resolution Team Operations Director, you will be accountable for the day-to-day operations and performance of various complaint types handled by the Resolution team including: Part C, Expedited Standard and post cases

Responsibilities

In this role, the Director will:


Provide strategic direction and leadership to the various operational teams
Meet or exceed all operational goals, including regulatory compliance requirements
Promote and build an 'Member Ready Every Day' culture
Further simplify and improve processes across the various teams and drive additional operational efficiencies
Collaborate with upstream business partners to identify opportunities and drive initiatives that will ultimately reduce the number of complaints received by the Resolution team
Work closely with and support other Resolution leaders to achieve overall Resolution team operational goals, including transformation strategy
Increase Stars scores by improving timeliness and decision making
Leads by example to cultivate a climate of motivation, positive energy and meaning in work. Assesses, selects, recognizes, develops, and empowers diverse talent.
Guides and energizes others, models adaptability, and inspires strong organizational performance through periods of transformation, ambiguity, and complexity.


Role Essentials


Extensive experience in leading large scale, highly complex operations with proven results
Financial savviness with the ability to manage staffing models and a multi-million dollar budget
Strong healthcare business acumen and analytical skills
Operational mindset with experience leading processes and implementation
Passion for people development and demonstrated leadership success
High emotional intelligence
Excellent interpersonal, organizational, communication and presentation skills
Ability to effectively interact with and influence all levels of the organization, including front line associates and senior leadership
Proven ability to drive accountability and engagement at all levels of the organization
Bachelor's degree in business or other related field (Masters preferred)


Preferred skills


Experience with Medicare Appeals


Additional Information

It is highly preferred that this Director reside in or relocate to the Louisville, KY area, however other locations will be considered.

Scheduled Weekly Hours

40

Company info

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