Remote Grievances & Appeals Specialist (Medicare Part B)

Humana, Inc.; Helena (MT); Remote; USD 43,000 - 56,000; Full time

Benefits offered by this job

Remote work

Health benefits

401(k) retirement plan

Job summary

Humana, Inc. is seeking a Grievances & Appeals Representative 3 to manage members and provider Part B denials and concerns by conducting analytic reviews of clinical documentation to determine if a grievance or appeal is warranted.

You will deliver final determination based on trained skillsets and partnerships with clinical and Humana colleagues. You will perform advanced administrative and customer support tasks that require independent initiative, judgment, and the ability to work in a

Qualifications

• 1+ year of customer service experience, call center or retail.
• Healthcare or medical field experience.
• 1+ year of grievance and appeals (G&A) experience.
• Experience in a production and QA driven environment.
• Strong data entry skills with Word and Excel.
• Willing to work flexible hours including Sundays and overtime.

Responsibilities

• Assist members and provider offices by phone.
• Investigate and resolve G&A issues for Part B claims.
• Meet production goals and QA metrics.
• Decide on methods and processes for tasks.
• Prioritize requests and adapt procedures as needed.
• Work remotely with limited guidance.

Skills

Customer service

Healthcare industry experience

Grievance & Appeals

Data entry

Microsoft Word & Excel

Job description

Humana, Inc. is seeking a Grievances & Appeals Representative 3 to manage members and provider Part B denials and concerns by conducting analytic reviews of clinical documentation to determine if a grievance or appeal is warranted.

You will deliver final determination based on trained skillsets and partnerships with clinical and Humana colleagues. You will perform advanced administrative and customer support tasks that require independent initiative, judgment, and the ability to work in a