Grievance & Appeals Representative
Work at Home - Wisconsin
The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if an a grievance, appeal or further request is warranted and then delivers final determination based on trained skillsets and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills.
The Grievances & Appeals Representative 3 assists members, via phone or face to face, further/support quality related goals. Investigates and resolves member and practitioner issues. Decisions are typically focus on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, andworks under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge.
Use your skills to make an impact
We are only considering candidates who live within 50 miles and/or 1 hour of one of the following Humana locations:
· Louisville, KY
· Tampa, FL
· San Antonio, TX
· Green Bay, WI
Required Qualifications
· 2+ years of customer service experience
· Must have experience in the healthcare industry or medical field
· Strong data entry skills
· Intermediate experience with Microsoft Word and Excel
· Must have experience in a production driven environment
· Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Required Work Schedule:
Training:
· Virtual training will begin May 20th, 2024, and runs for 5 weeks with a schedule of 8:00 am – 4:30 pm EST, Monday – Friday.
· Please note that training is a critical stage of associate development. Attendance is vital for your success, so no time off, other than observed holidays, is allowed during training.
· New Hire Training requires you to be appropriately dressed, on time and on camera via the facilitated Zoom classroom instruction for attendance.
Work Hours:
· Once out of training, you must be available to work either one of these schedules:
· Sunday – Thursday 10:30 AM- 7:00PM EST
· Tuesday - Saturday 10:30 AM- 7:00PM EST
(Mandatory Overtime and business need for inventory, may include weekend days and holidays. Hours are subject to change based on …
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Work from a dedicated space
Benefits/PerksCompetitive benefits Dental Life Insurance Medical Paid parental and caregiver leave Paid Time Off Parental and Caregiver Leave Personal holidays Time off Vision Vision Benefits Volunteer time
Tasks- Training
Analytic Business Clinical Documentation Communication Computer Customer service Data Entry Excel Healthcare Leadership Medicaid Medical terminology Medicare Microsoft Excel Microsoft Word Organizational
Education TimezonesAmerica/Anchorage America/Chicago America/Denver America/Los_Angeles America/New_York Pacific/Honolulu UTC-10 UTC-5 UTC-6 UTC-7 UTC-8 UTC-9