Medicaid Appeals Specialist - Remote & Fast-Paced

Humana; Frankfort (KY); A distancia; USD 43.000 - 56.000; Jornada completa

Descripción de la vacante

Humana is seeking a Grievances & Appeals Representative 3 to handle expedited Medicaid and AIP (dual) appeals, reviewing clinical documentation to determine if an appeal is warranted. This fast-paced, high-volume role requires proactive queue management and clear communication with managers and team leads.

You will manage cases end-to-end, perform analytic reviews, assess urgency, and ensure timely resolutions.

Formación

• 1 year of customer service experience.
• 1 year in the healthcare industry or medical field.
• Experience with production and meeting performance metrics.
• Proficient with Word, Excel, Outlook and Teams; able to use multiple systems.
• Adaptable to a high-volume, changing workload and priorities.

Responsabilidades

• Review and evaluate several expedited Medicaid and AIP cases per hour.
• Manage cases from assignment to resolution with analytic reviews of documentation.
• Assess case urgency and process within 24-hour turnaround times.
• Make outbound calls to deliver outcomes or request documentation.
• Stay current with mentor documents and workflows.
• Monitor multiple workstreams and adapt quickly to changes.
• Communicate gaps or issues and seek guidance as needed.

Conocimientos

Customer service

Healthcare knowledge

MS Office

High-volume workload

Communication

Herramientas

Microsoft Office

Descripción del empleo

Humana is seeking a Grievances & Appeals Representative 3 to handle expedited Medicaid and AIP (dual) appeals, reviewing clinical documentation to determine if an appeal is warranted. This fast-paced, high-volume role requires proactive queue management and clear communication with managers and team leads.

You will manage cases end-to-end, perform analytic reviews, assess urgency, and ensure timely resolutions.