Grievances and Appeals 3
HumanaSalary not specified
Full Time
Junior (1 to 2 years), Mid-level (3 to 4 years)
Not SpecifiedCompensation
Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Health Insurance, HealthcareIndustries
Requirements
Candidates must have experience with Medicare Advantage appeals and grievances, strong attention to detail, and a commitment to data accuracy. They should possess excellent customer service and conflict resolution skills, particularly with frustrated or vulnerable members. Strong time management, organizational skills, and the ability to meet deadlines consistently are essential. The role requires the ability to work independently and collaboratively, with strong written and verbal communication skills to explain complex information clearly. A Bachelor's degree or equivalent experience in healthcare, conflict resolution, or a related field, along with working knowledge of insurance products, policies, procedures, and claims processes, is desired. Superior investigative, analytical, and problem-solving skills, experience escalating cases, and strong computer and documentation skills are also preferred.
Responsibilities
The Grievance Specialist will maintain up-to-date knowledge of Devoted Health products, benefits, policies, and procedures. They will conduct thorough investigations by reviewing case details, member records, and relevant policies/procedures for root cause analysis. Responsibilities include effectively triaging work to ensure grievances are accurately categorized and routed, communicating with members through written correspondence and telephone contact, and completing accurate documentation and data entry across multiple systems. The specialist will ensure all grievances are resolved within required regulatory and departmental timelines, collaborate with internal partners to gather information and resolve cases thoroughly, and contribute to identifying themes and opportunities for improvement in processes or member experience.
Skills
Grievance Resolution
Regulatory Compliance
Case Management
Root Cause Analysis
Member Relations
Communication
Attention to Detail
Triage
Devoted Health
Medicare Advantage plans with personalized support
About Devoted Health
Devoted Health provides Medicare Advantage plans aimed at simplifying and making healthcare more affordable for seniors aged 65 and older. Their plans include services like provider and pharmacy searches, prescription drug coverage, and preventive care rewards. Members pay premiums for these plans, and the company may also receive government payments for managing Medicare benefits. What sets Devoted Health apart from competitors is their high level of customer service, featuring Devoted Health Guides who assist members in navigating their healthcare options and addressing common issues with traditional insurance. Additionally, they promote preventive care through the Devoted Dollars program, which rewards members for engaging in health activities. The goal of Devoted Health is to create a more compassionate and accessible healthcare experience for its members.
Waltham, MassachusettsHeadquarters
2017Year Founded
$2,194.5MTotal Funding
SERIES_ECompany Stage
HealthcareIndustries
1,001-5,000Employees