Grievances & Appeals Rep - Internal Revenue Team

Humana

256d • $48,300 - $65,900 • Remote

About The Position

Be a part of our caring community and help us put health first. The Grievances & Appeals Representative 4 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if 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 4 assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment. The Grievances & Appeals Representative 4 assists members, teammates and other management personnel via phone or face to face, further supporting quality related goals. Investigates and resolves member and practitioner issues. Decisions are regarding the daily priorities for an administrative work group and/or external vendors including coordinating work activities and monitoring progress towards schedules/goals, and often oversees work of others and/or is the primary administrative owner of a main process, program, product, or technology. Works within broad guidelines with little oversight.

Requirements

• 2 years of healthcare or insurance experience.
• Strong data entry skills required.
• Intermediate experience with Microsoft Word and Excel.
• Experience in a production driven environment.
• Passionate about contributing to an organization focused on improving consumer experiences.

Nice To Haves

• Associate's or Bachelor's Degree.
• Previous inbound call center or related customer service experience.
• 1 year of leadership experience.
• 2 years of grievance and appeals experience.
• Previous experience processing medical claims.
• Bilingual (English and Spanish); with the ability to read, write, and speak both languages.

Responsibilities

• Manage client denials and concerns through analytic review of clinical documentation.
• Determine if a grievance, appeal, or further request is warranted.
• Deliver final determinations based on trained skillsets and partnerships.
• Assist members, teammates, and management personnel via phone or face to face.
• Investigate and resolve member and practitioner issues.
• Coordinate work activities and monitor progress towards schedules/goals.
• Oversee work of others and/or be the primary administrative owner of a main process.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off including company and personal holidays, volunteer time off, paid parental and caregiver leave.
• Short-term and long-term disability.
• Life insurance.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree