Bilingual Supervisor, Grievance & Appeals

Description

The Bilingual Supervisor, Grievances & Appeals manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if a grievance, appeal or further request is warranted and then delivers final determination based on trained skillsets and/or partnerships with clinical and other Humana parties.

Responsibilities

The Bilingual Supervisor, Grievances & Appeals assists members, via phone or face to face, further/support quality related goals. Investigates and resolves member and practitioner issues.

• Team member support quality related goals

• Investigates and resolves member and practitioner issues

• 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

• Associate Engagement and development

Required Qualifications

• 2 or more years leadership experience in healthcare which includes streamline daily operations, coaching and developing associates.

• 2 or more years in experience working in a Healthcare high volume /call center production environment (in the past 5 years)

• 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.

• Advanced proficiency in Microsoft Office programs including Word and Excel

Preferred Qualifications

• Bachelor's Degree

• Previous experience working in Grievance and Appeals

• Advanced knowledge in Microsoft PowerPoint and Access

• Strong knowledge of CMS Appeals regulations

Additional Information

Schedule: Monday to Friday from 8 am to 5 pm EST with Overtime to meet business needs.

Travel: 5%

# of Direct Reports: 15

Language Proficiency Testing

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.

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.  If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/yammer and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.