Grievance and Appeals Representative 4
Humana•Boston, MA
400d•$43,400 - $59,600•Remote
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About The Position
The Grievances & Appeals Representative 4 plays a crucial role in managing client denials and concerns by conducting thorough reviews of clinical documentation. This position is responsible for determining the necessity of grievances or appeals and delivering final determinations based on established skillsets and collaboration with clinical teams. The representative also provides support to members, ensuring quality-related goals are met, and investigates and resolves issues raised by members and practitioners. This role requires independent initiative and judgment, as well as ownership of administrative and operational duties within a remote work environment.
