Dover, DE
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Grievances and Appeals Representative 4 - Work at Home/Remote EST and CST
Dover, DE
Apply Now >
Grievance & Appeals Representative 3
Humana Inc.
Dover, DE
Apply Now >
Grievance and Appeals Representative 2 for IRT- Work at Home/Remote USA
Humana Inc.
Dover, DE
Apply Now >
Grievances and Appeals Representative 4 - Work at Home/Remote CST/EST
Humana Inc.
Dover, DE
Apply Now >
Supervisor Grievances amp Appeals
Company name
Humana Inc.
Location
Dover, DE, United States
Employment Type
Full-Time
Industry
Customer Service, Bilingual
Posted on
Mar 05, 2022
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
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 10x1 (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
Company info
Humana Inc.
Website : http://www.humana.com
Location : Dover, DE
Location : Dover, DE
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Employer job 
90 Day Old Job