Grievances and Appeals Representative
Location
Remote | United States
Job description
Become a part of our caring community and help us put health first
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!
What we need your help with:
- Managing 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.
Use your skills to make an impact We are only considering candidates who live within 50 miles of one of the following locations:
- Louisville, KY
- Tampa, FL
- San Antonio, TX
- Green Bay, WI
- San Juan, PR
Required Qualifications
- 2+ years working with customers in a fast-paced, deadline-oriented environment
- Prior experience interpreting Member Benefits and Medical Claims
- Experience with the ability to prioritize and manage inventory and workflow
- Customer focused, analytical and 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
- High level of emotional intelligence with a proven ability to influence office culture and engagement in a positive manner
Required Work Schedule :
Training :
- Virtual training will begin April 8th, 2024 and runs for 8-10 weeks with a schedule of 8:00 am – 4:30 pm EST, Monday – Friday.
- Please note that training is a critical stage of associate development. Attendance is vital for your success, so no time off, other than observed holidays, is allowed during training.
- New Hire Training requires you to be appropriately dressed, on time and on camera via the facilitated Zoom classroom instruction for attendance.
Work Hours:
- Your shift will fall between start time of business hours of 8:00AM to 6:00PM EST, Monday – Friday.
- (Mandatory Overtime and business need for inventory, may include weekend days and holidays. Hours are subject to change based on business needs but are always communicated ahead of the need.)
- Grievances and Appeals (G&A) has an impact to our business and because of the complexities of our work, there is an 18-month commitment to this department. G&A will not allow transitions outside of area prior to the end of the 18 months.
Preferred Qualifications
Additional Information
Please be sure to include your resume with your application!
Work From Home:
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
- Satellite, cellular and microwave connection can be used only if approved by leadership
- Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Interview Process
- Prescreen : Shortly after submitting your application, you may receive both a text message and email requesting you to complete 10 to 15 prescreen questions with either yes or no answers. The text message may arrive prior to the email. If you prefer to answer via computer or tablet, wait for the email.
- Assessment: If the prescreen is passed, you will receive another communication to take the Grievances and Appeals Assessment. This is an online activity where you will see a Realistic Job Preview to learn more about the job and then be asked to answer questions where 30 minutes should be set aside to complete. You can complete the assessment on your phone, tablet, or computer; however, most candidates prefer using a computer or tablet.
- Interviews : Some candidates will be invited to interview. If so, the recruiter will reach out to schedule. A writing sample may or may not be required.
- Offers : Finalists from the interview will be contacted by the recruiter to discuss an offer for the job
- Note : Depending on the number of openings, the number of candidates who apply, and the schedules of interviewers and recruiters, this process may take several weeks or less; however, know that we are working hard to proceed as quickly as possible and to keep you informed.
Scheduled Weekly Hours
40
About us Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Job tags
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