Remote Grievances & Appeals Specialist - Medicare Part B

Humana, Inc.; Cheyenne (WY); Teletrabalho; USD 43 000 - 56 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off

Parental and caregiver leave

Resumo da oferta

Humana, Inc. is seeking a Grievances & Appeals Representative 3 to support members and providers remotely. You will review clinical documentation and deliver final determinations with collaboration from clinical and Humana teams.

This role emphasizes independent initiative, analytical review, and strong administrative judgment. The position requires healthcare or related experience, familiarity with Part B processes, and the ability to work from home while meeting production goals.

Qualificações

• 1+ years of customer service (e.g., call center or retail) experience.
• Experience in healthcare, pharmaceutical, or medical field.
• 1+ years of grievance and appeals (G&A) experience.
• Experience in a production and QA-driven environment.
• Strong data entry skills including Word and Excel.

Responsabilidades

• Assist members and provider offices by phone.
• Investigate and resolve issues for Medicare Part B Pharmacy, dual eligible Medicare/Medicaid, diabetic supply and related claims.
• Follow production goals and QA metrics.
• Make decisions on methods, tactics and processes for administrative tasks/projects.
• Exercise discretion prioritizing requests and interpreting procedures.
• Work remotely with limited guidance.

Conhecimentos

Customer service

Healthcare industry experience

Grievances & Appeals experience

Data entry (MS Office)

Ferramentas

Microsoft Word

Microsoft Excel

Descrição da oferta de emprego

Humana, Inc. is seeking a Grievances & Appeals Representative 3 to support members and providers remotely. You will review clinical documentation and deliver final determinations with collaboration from clinical and Humana teams.

This role emphasizes independent initiative, analytical review, and strong administrative judgment. The position requires healthcare or related experience, familiarity with Part B processes, and the ability to work from home while meeting production goals.