Grievance & Appeals Representative

Become a part of our caring community and help us put health first
 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 business needs but are always communicated ahead …