Description
The Grievances & Appeals Lead supports the Medicare Grievance organisation by coordinating Issue of Performance (IOP) oversight, driving corrective actions, supporting CMS audit readiness, and helping reduce compliance risk while advancing quality goals.
As the Grievances & Appeals Lead, you will:
- Lead IOP identification, monitoring, trending, and reporting across grievance teams
- Coordinate corrective action plans and remediation efforts
- Partner with operational leaders to resolve identified risks promptly
- Support CMS audit readiness activities, including documentation, reporting, and governance routines
- Oversee compliance-related performance metrics and emerging operational risks
- Advise executives on functional strategies related to quality, compliance, and grievance operations
Required Qualifications
- 7+ years in healthcare operations, compliance, process improvement, project management or related field
- 1+ year of Medicare Grievances experience
- 2+ years of project leadership experience
- Advanced experience with reporting and Power BI
- Experience analysing data, identifying trends and root causes, and supporting remediation efforts
Preferred Qualifications
- Lean or Six Sigma certification
- CMS program audit experience
- Knowledge of Microsoft Access or experience with SQL Server databases
- Experience using data and AI-driven insights to support process improvement and metric remediation
- Bilingual (English and Spanish); with the ability to read, write, and speak English and Spanish
Work Arrangements
- Remote position with occasional travel to Humana's offices for training or meetings
- Must have a dedicated workspace with reliable internet (minimum 25 Mbps download, 10 Mbps upload)
Scheduled Weekly Hours
- 40 hours per week
Pay Range
- $86,300 - $118,700 per year
Benefits
- Medical, dental, and vision benefits
- 401(k) retirement savings plan
- Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
- Short-term and long-term disability
- Life insurance
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