Remote Grievances & Appeals Specialist – Medicare Part B

Humana, Inc.; Salt Lake City (UT); Remote; USD 43,000 - 56,000; Full time

Job summary

Humana, Inc. is seeking a Grievances & Appeals Representative 3 to manage members and provider Part B denials, performing analytic reviews of clinical documentation to determine if a grievance or appeal is warranted. You will deliver final determinations and support with clinical partnerships.

You will work remotely in a 40-hour week, with shifts aligning to EST business hours and potential overtime. The role requires strong customer service, healthcare experience, and familiarity with Medicare

Qualifications

• 1+ years of customer service experience.
• Experience in the healthcare industry 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 the Microsoft Office suite (Word and Excel).
• Must be able to work any day Sunday – Saturday, 8-hour shifts between 7 a.m. - 7 p.m. EST, with possible overtime.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

Responsibilities

• Assist members and provider offices by phone.
• Investigate and resolve member and practitioner issues for Medicare Part B Pharmacy, dual eligible Medicare/Medicaid, diabetic supply and related claims.
• Follow company and department production goals and QA metrics.
• Make decisions on methods and processes for completing tasks.
• Exercise discretion and judgment in prioritizing requests and interpreting procedures.
• Work in a remote/work at home setting under limited guidance.

Skills

Customer service

Healthcare industry

G&A experience

Data entry

Microsoft Word

Microsoft Excel

Tools

PaHub

Job description

Humana, Inc. is seeking a Grievances & Appeals Representative 3 to manage members and provider Part B denials, performing analytic reviews of clinical documentation to determine if a grievance or appeal is warranted. You will deliver final determinations and support with clinical partnerships.

You will work remotely in a 40-hour week, with shifts aligning to EST business hours and potential overtime. The role requires strong customer service, healthcare experience, and familiarity with Medicare