Become a part of our caring community and help us put health first

The Resolution Team is an operating area of the Consumer and Provider Services and Solutions (CPSS) organization, responsible for delivering exceptional consumer experience by effectively understanding, resolving, and ultimately preventing problems and complaints. This leader will have operational responsibility to ensure grievances and appeals for Medicare, Careplus, Medicaid, and Specialty lines of business are resolved in a consumer friendly, efficient, timely and manner.

The AVP, Grievances & AppealsResolution Team will provide strategic leadership and operational support for the organization’s overall monthly complaint receipts. Scope also includes operational support in with vendor partnerships, contract reviews, sourcing new capabilities, creating efficiencies and influencing quarterly business reviews change across the enterprise that enhances the consumer experience.

The AVP, Resolution TeamGrievances & Appeals must be an experienced leader with a demonstrated record of driving significant results across large and complex organizations in a collaborative and engaging manner. This leader will guide the support operational team to identify operational improvement opportunities, including cross-training initiatives and cost reductions transformation. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes. The operational team is responsible for day-to-day run the business which includes resolving inquiries, hitting meeting compliance expectations, managing vendor partners, and focusing on consumer experience.

Use your skills to make an impact

Required Qualifications

• 5 or more years of management experience (leading a large team within Operations environment at a large corporation)
• 5 or more years of healthcare/managed care industry experience
• Proven ability to excel in a dynamic, changing, and fast-paced environment
• Prior leadership experience driving process improvement, leveraging data and analytics, and ensuring regulatory compliance
• A strong commitment to team and professional development, with demonstrated ability to hire, mentor, and develop future leadership talent
• Strong computer skills (e.g. Excel, Word, PowerPoint and other programs required for assimilating and presenting reports)
• Excellent communication and presentation skills to include the ability to communicate and present technical details to Senior VP level leadership and/or Senior Government officials
• Sound business and financial acumen with ability to apply knowledge to business challenges

Preferred Qualifications

• Bachelor’s degree, preferably in a business-related field, or advanced degree
• Experience with Grievance and Appeals (Humana process or systems knowledge ideal)
• Strong digital and technical acumen with implementation or significant change experience
• Exceptional Operational experience ideally working within a large matrixed organization.

Additional Information

• This position is remote Central or Eastern time zone. Preference will be given to candidates within a reasonable driving distance to Louisville, KY. In office expectation is 1-2 times a month.
• Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

• To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees 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
  Employees 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 employees 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

• Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:
  Health benefits effective day 1
  Paid time off, holidays, volunteer time and jury duty pay
  Recognition pay
  401(k) retirement savings plan with employer match
  Tuition assistance
  Scholarships for eligible dependents
  Parental and caregiver leave
  Employee charity matching program
  Network Resource Groups (NRGs)
  Career development opportunities

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 decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$164,700 - $226,600 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 because he or she is a protected veteran. 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.