Bilingual Grievance & Appeals Quality Audit Professional
Are you a detail-oriented and bilingual professional with a passion for ensuring high quality standards? Are you looking for a rewarding career opportunity where you can make a difference in the lives of others? Look no further! Humana is seeking a Bilingual Grievance & Appeals Quality Audit Professional to join our team. In this role, you will be responsible for conducting quality audits of grievance and appeals processes to ensure compliance with regulatory requirements and company policies. You will have the opportunity to use your bilingual skills to communicate effectively with diverse populations and resolve complex issues. If you have a strong background in quality assurance and a dedication to improving the customer experience, we invite you to apply today!
- Conduct quality audits of grievance and appeals processes to ensure compliance with regulatory requirements and company policies.
- Review and analyze data to identify any trends or patterns in customer complaints and appeals.
- Create and maintain detailed reports and documentation of audit findings.
- Collaborate with cross-functional teams to develop and implement corrective action plans.
- Utilize bilingual skills to effectively communicate with diverse populations and resolve complex issues.
- Serve as a subject matter expert on regulatory requirements and company policies related to grievance and appeals processes.
- Identify areas for improvement in processes and procedures and make recommendations for enhancements.
- Train and educate team members on quality standards and best practices.
- Monitor and track progress of corrective action plans and report on outcomes.
- Continuously evaluate and improve quality assurance processes to ensure maximum efficiency and effectiveness.
- Remain up-to-date on industry standards and changes in regulatory requirements.
- Maintain confidentiality and adhere to all HIPAA regulations.
- Provide excellent customer service to internal and external stakeholders.
- Collaborate with other departments to resolve escalated customer issues.
- Contribute to a positive and inclusive work environment by promoting teamwork and open communication.
Fluency In English And At Least One Other Language: The Ideal Candidate For This Role Should Be Proficient In Both Written And Spoken English, As Well As Another Language Such As Spanish, Mandarin, Or Arabic. This Is Necessary In Order To Effectively Communicate With A Diverse Member Base And Accurately Assess The Quality Of Appeals And Grievances In Various Languages.
Analytical Skills: A Successful Bilingual Grievance & Appeals Quality Audit Professional Must Possess Strong Analytical Skills In Order To Review, Assess, And Interpret Data Related To Appeals And Grievances. This Includes The Ability To Identify Trends And Patterns, As Well As To Make Data-Driven Recommendations For Improvement.
Understanding Of Healthcare Regulations: A Deep Understanding Of Healthcare Regulations, Such As Hipaa And Medicare Guidelines, Is Essential For This Role. The Candidate Should Be Familiar With The Rules And Processes Surrounding Appeals And Grievances In Order To Ensure Compliance And Accuracy In Their Audits.
Quality Assurance Experience: Previous Experience In A Quality Assurance Role Is Highly Desirable For A Bilingual Grievance & Appeals Quality Audit Professional. This Could Include Experience In Auditing, Compliance, Or Quality Control, Preferably In A Healthcare Or Insurance Setting.
Strong Communication Skills: Effective Communication Is Crucial For A Bilingual Grievance & Appeals Quality Audit Professional. This Includes The Ability To Provide Clear And Concise Feedback To Team Members, As Well As To Effectively Communicate With Members And Providers Regarding Appeals And Grievances. The Candidate Should Also Possess Strong Writing Skills In Both English And The Second Language In Order To Accurately Document Audit Findings.
Quality Assurance
Data Analysis
Communication
Attention to detail
customer service
Compliance Knowledge
Problem-Solving
Audit Procedures
Bilingual Proficiency
Grievance Handling
Appeals Process
Communication
Conflict Resolution
Leadership
Time management
creativity
Teamwork
Adaptability
Problem-Solving
Empathy
Decision-making
According to JobzMall, the average salary range for a Bilingual Grievance & Appeals Quality Audit Professional is between $50,000 and $70,000 per year, with a median salary of $62,000. However, this can vary depending on factors such as location, experience, and employer. Some professionals in this role may also receive additional benefits such as bonuses, healthcare, and retirement plans.
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Humana Inc. is a for-profit American health insurance company based in Louisville, Kentucky. Its strategy integrates care delivery, the member experience, and clinical and consumer insights to encourage engagement, behavior change, proactive clinical outreach and wellness for the millions of people they serve across the country. The company operates its business through the following segments: Retail, Group, and Healthcare Services.
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