Grievances amp Appeals Representative - Remote

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 Grievance & Appeals Representative 3 role.

Responsibilities

What we need your help with:

You will manage 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.

COME GROW WITH HUMANA! BENEFITS DAY ONE - STELLAR 401K MATCH - PAID TIME OFF

What you need for success! - Required Qualifications

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

Prior experience interpreting Member Benefits and Medical Claims

Experience with case management or the ability to prioritize and manage inventory and work flow

Strong attention to detail, organizational and time management skills with the ability to interpret, research and identify core issues

Strong customer focus, analytical and decision making skills

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

Work at Home Requirements

Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

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

Associate's or Bachelor's Degree

Prior experience with Humana's operating systems: MHK (MedHok), SRO / CAS / ARGUS, CI, CGX

Prior Medicare experience

Prior experience with CMS Guidelines and remaining compliant

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

Additional Information

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

Department Hours are 6:00am to 6:00 pm EST. Your starting shift will likely be Monday - Friday 8:00am - 5:00pm EST, however, hours are sub ject to change based on business needs.

Scheduled Weekly Hours

40

Company info

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