HOMELAND LLC Is Hiring A Bilingual Supervisor of Complaints, A&G and Correspondence - Remote

Job SummaryHomeland has partnered with a leading provider of employee benefits, specializing in dental health coverage for millions across the U.S. Our client is seeking a Bilingual Appeals and Grievance Supervisor to join their team.

As the Bilingual Appeals and Grievance Supervisor, you will be instrumental in championing member advocacy for our members and providers. Leading a dedicated team, your primary focus will be to ensure that every appeal or grievance is addressed promptly and fairly, cultivating a culture of trust and transparency. Your expertise will drive compliance with regulations while identifying opportunities for process improvements that enhance satisfaction for both members and providers. By leveraging data and insights, you will help shape our service delivery and empower your team to excel.

The Appeals and Grievances team is dedicated to providing fair and timely resolutions regarding healthcare benefits. They manage a variety of cases, carefully investigating each one to ensure that all concerns are addressed. Their primary goal is to advocate for members and providers, ensuring members receive the care they need without unnecessary barriers, while also providing a clear process for providers to address benefit decisions. By identifying trends in appeals and grievances, we continuously strive to improve our processes and boost overall satisfaction.

In this role, you will serve as a vital link between members, providers, and the organization, promoting trust and transparency in all our efforts. In this position, you will oversee the daily operations of the appeals and grievances team, managing case intake, investigation, and resolution processes to ensure timely responses to concerns from members and providers. You will also provide high-level oversight of all correspondence to members and providers. Each day, you will guide and support your team, conducting regular check-ins to discuss ongoing cases and address challenges. Monthly, you will analyze data on appeal trends and prepare detailed reports for senior management, highlighting insights and recommendations for process enhancements. As a leader, you will leverage your knowledge of regulations and industry best practices to ensure compliance and improve the overall efficiency of the appeals process and correspondence generation. Your efforts will directly contribute to enhancing member and provider satisfaction and trust in our services.

Responsibilities

• Apply regulations and compliance standards governing appeals and grievances processes and correspondence generation
• Manage complex cases, ensuring thorough investigations and timely resolutions for appeals and grievances
• Oversee the implementation and updates of all correspondence templates for the organization
• Ensure operational processes and procedures are established and followed for all correspondence-related activities
• Analyze trends and outcomes related to appeals and grievances, using data to support informed decision-making and process improvements
• Develop and implement quality control measures to ensure compliance and improve outcomes for appeals, grievances, and correspondence
• Navigate difficult conversations and resolve conflicts effectively and diplomatically
• Inspire and motivate team members, fostering a collaborative and productive work environment
• Possess excellent verbal and written communication skills for interacting with members, stakeholders, team members, and providers
• Possess strong analytical and critical thinking abilities to identify issues and develop effective solutions
• Maintain a high level of accuracy and attention to detail in managing cases and documenting processes
• Demonstrate a commitment to understanding and addressing the needs and concerns of members, ensuring a positive experience

Requirements

• Bachelor's degree in Healthcare Administration, Business Administration, Social Work, OR 4-6 years of experience in Claims Administration
• 1-3 years of experience in appeals and grievances management (preferably in healthcare or insurance)
• 1-3 years experience applying regulations and compliance standards related to appeals and grievances
• 1-3 years experience in Excel (ability to create pivot tables, custom formulas, and VLOOKUP)
• 1-3 years experience aggregating data for tracking and trending
• 1-3 years experience utilizing strong analytical skills to identify trends and convert data into written responses for partners, process improvements, and innovation
• Proficient in all Microsoft Office products
• 1-3 years of experience managing multiple priorities under tight deadlines
• Aptitude for quick decision-making, adapting between priorities and projects, and communicating changes
• Ability to work independently
• 1-3 years of supervisory or leadership experience with a track record of managing and developing teams
• Excellent verbal and written communication skills; effective interaction with members, stakeholders, and team members
• Commitment to advocacy and exceptional customer service
• Fluent in both English and Spanish or Haitian-Creole (oral and written)
• 1+ year of experience in a dental and/or optical office
• Registered Dental Hygienist or Dental Assistant
• Strong understanding of Medicaid policies and procedures related to dental and vision services
• 1+ year of leadership experience

BenefitsOur client provides meaningful and challenging work that fosters innovation in a secure and compliant environment, alongside a competitive compensation package. Benefits include comprehensive medical, dental, vision, life, and disability coverage for employees and their dependents with no waiting period, a 401(k) plan with company match, tuition assistance, paid parental leave, and backup family care. Their collaborative workspaces encourage creativity and talent development, while flexible time off, dress code, and work location policies promote work-life balance. The company values inclusion and diversity through Employee Resource Groups and is dedicated to social responsibility, community outreach, educational partnerships, and sustainability efforts.

SummaryApply today!

EEO NoticeHomeland LLC is an Equal Opportunity Employer. Homeland LLC provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state, and local laws. Homeland LLC complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. Reasonable accommodation is available for qualified individuals with disabilities, upon request.