Kansas Works Jobs

Kansas Works Logo

Job Information

Humana Supervisor, Grievances & Appeals - Louisville, KY (Waterside), Green Bay, WI, or Cincinnati, OH in Overland Park, Kansas

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

  • Bachelor's Degree or equivalent work experience

  • 2- 4 years of customer service experience

  • Minimum of a year 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

Additional Information

Work at Home/Remote Requirements

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 is required

Scheduled Weekly Hours

40

DirectEmployers