Supervisor, Grievance & Appeals

Become a part of our caring community and help us put health first
 The Supervisor, Grievances & Appeals is an inventory based role, supporting a team of associates assisting members and providers with appeal resolutions. This position will also support quality related go

The Supervisor, Grievances & Appeals is an inventory based role, supporting a team of associates assisting members and providers with appeal resolutions. This position will also support quality related goals.

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.

Use your skills to make an impact
 

Required Qualifications

• Bachelor's Degree
• 4 - 6 years of customer service experience
• Clinical background experience (for example CNA/ LPN)
• Minimum of 2 years prior supervisory experience
• Experience working in a high volume production environment
• Previous experience working in the healthcare industry or medical field
• Excellent written, verbal and electronic communication skills
• Advanced proficiency in Microsoft Office programs including Word, Excel, and Outlook
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Previous experience working in Grievance and Appeals
• Beginner knowledge in Microsoft PowerPoint and Access
• 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

WORK STYLE: Work at home/remote, with very occasional need for travel for on-sites, trainings, conferences, and/or trainings.

Remote Locations include: TX KY IN WI and PR.

Additional Information

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

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$63,400 - $87,400 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
 Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.