Grievances and Appeals Representative 4 - Remote/WAH EST

Profile

Description

Responsibilities

This position can be in office or work at home in EST or CST and will provide coverage for eastern time zone hours. Weekend work required. Schedules will be from Thursday - Monday.

The Grievances & Appeals Representative 4 assists members, further/support quality related goals. Reviews the level 1 appeals cases and ensures that information is correct and then forwards to CMS entity for further review. 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 is the primary administrative owner of a main process, program, product or technology.

Works within broad guidelines with little oversight.

Required Qualifications

Must be able to work an 8 hour shift from Thursday through Monday.

Strong data entry skills required

1-3 years of customer service experience

Strong proficiency with Microsoft Word and Excel

Must have experience in a production driven environment

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Work at Home/Remote Requirements

Must ensure designated work area is free from distractions during work hours and virtual meetings

Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required

Preferred Qualifications

Associate's or Bachelor's Degree

Experience with electronic inventory management - able to complete assigned cases in a specified time frame.

Previous inbound call center or related customer service experience

2 - 4 years of grievance and appeals experience

CAS, PAHub and MedHOK experience strongly preferred

Previous experience processing medical claims

Bilingual (English and Spanish); with the ability to read, write, and speak English and Spanish

Scheduled Weekly Hours

40

Company info

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