Company name
Humana Inc.
Location
Glen Allen, VA, United States
Employment Type
Full-Time
Industry
Bilingual, Call Center, Customer Service
Posted on
Jul 14, 2022
Profile
Description
The Grievances & Appeals Representative 4 manages client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. 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.
Manages client medical denials by conducting a comprehensive analytic review of clinical documentation to assist with the process of working of an appeal.
Assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment
Required Qualifications
1 years of leadership experience
1 years of customer service experience
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
Strong data entry skills
Must have experience in the Healthcare Industry or Medical Field.
Intermediate experience with Microsoft Word and Excel
Must have experience in a production driven environment
WAH requirements:
Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
COVID VACCINATION : Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.
Preferred Qualifications
1 year Inbound Call Center experience
1 year experience Processing Medical Claims
Associate's or Bachelor's Degree
1 years of grievance and appeals experience
Additional information
Schedule: Monday to Friday from 8 am to 5 pm but be flexible with your hours based on business needs to work possible overtime
Training: 6 WEEKS Virtual Training
Work Location (Address): Remote anywhere within Easter time zone
Travel: 25% for UPS drop off
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.
#LI - Remote
#LI-EM1
Scheduled Weekly Hours
40
Company info
Humana Inc.
Website : http://www.humana.com