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The Resolution team handles all complaints for Humana, including formal grievances, appeals, inquiries and disputes. Our mission is to resolve these complaints quickly, effectively and with empathy. Additionally, we help Humana learn from customer complaints to continuously improve upstream processes and ultimately reduce the number of complaints we receive. We are currently in the midst of a people, process and technology transformation that will improve quality, timeliness and the overall experience for our associates, members and providers.As the Resolution Team Operations Director (Director, Grievance and Appeals), you will be accountable for the day-to-day operations and performance of various complaint types handled by the Resolution team including: Part C Appeals, Provider Disputes and/or other end compliant inquiries.
- Has 6-7 direct reports including Associate Directors, Managers, and Senior Professionals
- Provides strategic direction and leadership to the various operational teams
- Meets or exceeds all operational goals, including regulatory compliance requirements
- Promotes and builds an “Audit Ready Every Day” culture
- Further simplifies and improves processes across the various teams and drive additional operational efficiencies
- Collaborates with upstream business partners such as Claims, Clinical Guidance, and the Provider Network to identify opportunities and drives initiatives that will ultimately reduce the number of complaints received by the Resolution team
- Works closely with and support other Resolution leaders to achieve overall Resolution team operational goals, including transformation strategy
- Increases Stars scores by improving timeliness and decision making
- Leads by example to cultivate a climate of motivation, positive energy and meaning in work. Assesses, selects, recognizes, develops, and empowers diverse talent.
- Guides and energizes others, models adaptability, and inspires strong organizational performance through periods of transformation, ambiguity, and complexity.
In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:
- Medical Benefits
- Dental Benefits
- Vision Benefits
- Health Savings Accounts
- Flex Spending Accounts
- Life Insurance
- 401(k)
- PTO including 9 paid holidays, one personal holiday, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time
- And more
Use your skills to make an impact
Required Qualifications
- Bachelor’s degree in business or other related field
- 3+ years' of management experience in the healthcare industry and/or medical field (in the past 5 years)
- 3+ years’ experience with claims management
- Proven large scale inventory management skillset and experience in a production driven environment
- Experience managing multiple projects and assignments simultaneously and successfully
- Extensive experience in leading large scale, highly complex operations with proven results
- Strong business acumen and analytical skills
- Excellent interpersonal, organizational, communication and presentation skills
- Proven ability to drive accountability at all levels of the organization
Preferred Qualifications
- Masters degree
- Strong knowledge of CMS Grievance regulations
Additional Information
Work at Home/Remote Requirements
Work-At-Home Requirements
- 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 to support Humana applications, per associate.
- Wireless, Wired Cable or DSL connection is suggested.
- Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership. (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.)
- Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exception of associates who live or work from Home in the state of California, Illinois, Montana, or South Dakota. 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
Our Hiring Process
As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging, and/or Video Interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone or computer. You should anticipate this interview to take approximately 10-15 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay 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.$126,300 - $173,700 per yearThis 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.Application Deadline: 06-11-2025
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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.
