Grievance and Appeals Manager - Louisville KY Waterside

Profile

Description

The Grievance and Appeals Manager leads a team of 4-6 Supervisors and over 100 associates managing client denials and concerns. The team is conducting a comprehensive analytic review of clinical documentation to determine if any 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. The Grievance and Appeals Manager works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

Responsibilities

What we need your help with:


Lead a team of 100-110 associates that assists members, via phone or face to face, with the grievance and appeals process.
Develop and implement department plans to improve team's development, production, and engagement.
Continuously analysis and improve the department process for grievance and appeals.
Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area.
Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.
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


COME GROW WITH HUMANA! BENEFITS DAY ONE - STELLAR 401K MATCH - PAID TIME OFF - TUTION ASSISTANCE PROGRAMS - STELLAR WELLNESS/REWARDS PROGRAM

What you need for success! - Required Qualifications


Bachelor's Degree in healthcare administration, management, or business. or equivalent years of experience in a similar role
4 years of experience handling tasks related healthcare / medical claims
2 years of experience handling tasks related to grievance and appeals
2 years of management experience leading middle to large teams
Demonstrated capability with coaching and developing associates formally and/or informally
Ability to monitor and recommend improvements to increase team productivity by providing expert advice and assistance to other associates, as needed
Understands upstream and downstream impacts
Demonstrated ability to develop a strategic vision and deliver tangible outcomes
Ability to travel up to 30% overnight travel


Temporary Work at Home 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.


What you need to be STAND OUT among the crowd! : Preferred Qualifications


Master degree in healthcare administration, management or business
Strong understanding of Human Resource principles
Six Sigma or Lean experience

Strong organization and prioritization skills
Strong verbal and written communication skills
Passionate about contributing to an organization focused on continuously improving consumer experiences


Additional Information


In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.
#ThriveTogether #WorkAtHome


Scheduled Weekly Hours

40

Company info

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