Grievance and Appeals Specialist - Work at Home

Profile

Description

Do you enjoy helping those in need? Do you love researching, analyzing medical documents to determine if something was missed? Have you ever considered yourself a detective for medical claims / member benefits? Well if you answered yes to any of the above you may be a great fit for Humana's Grievances & Appeals Representative 3 role.

Responsibilities

What we need your help with:

Manages client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted.

Perform advanced administrative and/or customer support duties that require independent initiative and judgment.

From time to time apply intermediate mathematical skills and regularly exercise discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques.

Work under limited guidance at the comfort of your home due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge.

What you get from your great work! : Benefits and Perks of This Opportunity:

Competitive compensation with strong hourly rate and bonus eligibility

The ability to cut your daily commute to less than a minute!! Yes 100% Work at house capability.

Extensive 100% virtual training program for the first 6-8 weeks setting you up for immediate and future success.

Robust benefits as a full-time employee including health, dental, vision, tuition assistance, 401(k) and more. Effective first day - no waiting period!

Professional development opportunities including career advancement and mobility, virtual learning platforms, networking opportunities through our network resource groups, mentoring programs and more

What you need for success! - Required Qualifications

2 years working with customers in a fast-paced, deadline-oriented environment

Possesses a High School Diploma or GED

Prior experience interpreting Member Benefits and Medical Claims

Experience with the ability to prioritize and manage inventory and work flow

Customer focused, analytical, decision making skills-Works well under minimal supervision and takes initiative.

Strong technical skills with the ability to work across multiple software systems and comfortable work remote out of your home

Flexibility - ability to work overtime including weekends, based on business needs

Department Hours - Shift could fall between business hours of 6:00 am to 6:00 pm EST. Mandatory Overtime may include weekend days and holidays. Hours are subject to change based on business needs

High level of emotional intelligence with a proven ability to influence office culture and engagement in a positive manner

Work at home (WAH) requirements include a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes

What you need to be considered a Superstar! : Preferred Qualifications

Associate's or Bachelor's Degree

Humana's operating systems: MHK (MedHok), CCP/GCP/CAS, CI, CGX

Medicare experience

Experience with CMS Guidelines and remaining compliant

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com