Supervisor, Grievances & Appeals | Humana | Louisville, KY

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  • United States, Louisville, KY View on Map
  • Post Date : November 19, 2020
  • Apply Before : December 19, 2020
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Job 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

  • Minimum 2 years of previous experience with coordinating and leading projects and tasks
  • Demonstrated capability with coaching and developing associates formally and informally
  • Previous customer service experience
  • Experience managing in a high volume production environment with time sensitive parameters
  • Ability to individually prioritize high-risk work
  • Previous experience working in the healthcare industry or medical field
  • Excellent written, verbal and electronic communication skills
  • Ability to partner with multiple cross-functional departments
  • Intermediate knowledge of Microsoft Office programs including Word, Excel, and Outlook
  • Ability to commit to a Thursday-Monday shift with a focus on 8am – 4:30pm EST
  • 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 10×1 (10mbs download x 1mbs upload) for optimal performance of is required


Preferred Qualifications

  • Working knowledge of GCP, CAS
  • Previous experience working in Grievance and Appeals
  • Ability to create professional Microsoft PowerPoint presentations
  • 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


Scheduled Weekly Hours

40

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