Job Description
Bilingual Supervisor, Grievance & Appeals
Remote
Full time
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
Bilingual Supervisor, Grievances & Appeals
- 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
- Bachelor’s Degree
- Bilingual English and Spanish. Must be able to speak, read and write in both languages without limitations or assistance. See Additional Information on testing
- 3 or more years of Supervisory experience, which includes streamline daily operation, 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)
- Advanced experience with Microsoft Word and Excel
- Strong Analytical skills and root cause, implementation
Preferred Qualifications
- Previous experience working in Grievance and Appeals
- Advanced experience in Microsoft PowerPoint and Access
- Strong knowledge of CMS Appeals regulations
- Bilingual English and Spanish