Humana
10,000+ employees
Founded 1961
⚕️ Healthcare Insurance
Healthcare Insurance
Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.
Grievances & Appeals Representative
🔥 0 minutes ago
🗣️🇪🇸 Spanish Required
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Humana
10,000+ employees
Founded 1961
⚕️ Healthcare Insurance
Healthcare Insurance
Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.
📋 Description
• Manage client denials and concerns by conducting a comprehensive analytic review of clinical documentation • Deliver final determination based on trained skillsets and partnerships with clinical parties • Perform advanced administrative/operational/customer support responsibilities • Assist members by phone to further/support quality related goals • Investigate and resolve member and practitioner issues • Exercise discretion and judgment in prioritizing requests and interpreting procedures
🎯 Requirements
• Must reside in Puerto Rico • Bilingual (English and Spanish) • Two (2) years of customer service experience • Experience working in the healthcare industry or a medical field • Experience working in a production driven environment • Proficient in data entry and record management • Intermediate experience with Microsoft Word and Excel
🏖️ Benefits
• medical, dental and vision benefits • 401(k) retirement savings plan • time off (including paid time off, company and personal holidays, paid parental and caregiver leave) • short-term and long-term disability • life insurance
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