Grievances amp Appeals Representative 4 Bilingual English/Spanish. Appeals and Leadership exp. a MUST Miami FL

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Job Information
Humana
Grievances & Appeals Representative 4 (Bilingual English/Spanish. Appeals and Leadership exp. a MUST) Miami, FL
in
Miami
Florida
Description
The Grievances & Appeals Representative 4 manages client medical denials by conducting a comprehensive analytic review of clinical documentation to assist with the process of working of an appeal. The Grievances & Appeals Representative 4 assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment.
Responsibilities
The Grievances & Appeals Representative 4 assists members, via phone or face to face, further/support 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.
Required Qualifications
Prior experience in Appeals
1 years of leadership experience or related experience
Must be extremely organized and have strong time management
Intermediate experience with Microsoft Word and Excel
Must have experience in a production driven environment
Fully Bilingual English/Spanish. Must be able to speak, read and write in both languages without limitations or assistance. If selected for the position, you will be required to take a Language Proficiency Assessment in English/Spanish. See Additional Information on testing
Work At Home (WAH) - Temporary Due to COVID-19 emergency. Please note this permanent position allows you to work at home indefinitely until further notice. See additional information in section below.
WAH 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
Preferred Qualifications
Registered Nurse License
Previous inbound call center or related customer service experience
Previous experience processing medical claims
Additional information
Schedule
: Monday to Friday from 8 am to 5 pm, Overtime, sometimes is needed to work Saturdays.
Training: 1 month
, virtual
Work Location (Address): This permanent job is working from Home temporary due to Covid 19 emergency. This position will deploy to the following location at a future date:
11430 NW 20th Street | Doral, FL 33172
% Travel:5
Language Proficiency Testing:
Any Humana associate who speaks with a member in a language other than Spanish and/or English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government
Scheduled Weekly Hours
40

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