Grievances and Appeals Representative

Job not on LinkedIn

🔥 19 hours ago

🇺🇸 United States – Remote

💵 $43k - $56.2k / year

⏱ Part Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CenterWell Senior Primary Care

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

CenterWell Senior Primary Care is a healthcare provider focused on delivering personalized primary care to senior citizens. The company emphasizes a comprehensive and holistic approach to healthcare, addressing the physical, social, and emotional needs of older adults. As part of its service offerings, CenterWell includes home health services and pharmacy support to complement its senior primary care. The organization is committed to offering stability, inclusive benefits, and career growth opportunities for its employees while maintaining a culture of mutual respect and mindfulness. CenterWell is a brand under the larger healthcare entity, Humana.

📋 Description

• Manage member and provider denials and concerns • Conduct comprehensive analytic reviews of clinical documentation • Determine whether a grievance, appeal, or further request is warranted • Deliver final determinations through collaboration with clinical and other Humana parties • Perform advanced administrative and customer support tasks independently • Assist members and provider offices by phone • Investigate and resolve member and practitioner issues involving Medicare Part B Pharmacy, dual eligible Medicare/Medicaid, diabetic supply, and related claims • Follow company and department production goals and quality assurance metrics • Make decisions regarding methods and processes for administrative tasks and projects • Prioritize requests and interpret or adapt procedures, processes, and techniques

🎯 Requirements

• 1 or more years of customer service experience, such as call center or retail experience • Experience in the healthcare, pharmaceutical, or medical field • 1 or more years of grievance and appeals (G&A) experience • Experience in a production and quality assurance driven setting • Strong data entry skills, including the Microsoft Office suite (Word and Excel) • Ability to work 8-hour shifts on Friday, Saturday, and Sunday between 7 a.m. and 5 p.m. EST • Flexibility to adapt hours based on business needs • Passion for continuously improving consumer experiences • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • Ability to work from a dedicated space without ongoing interruptions to protect member PHI / HIPAA information

🏖️ Benefits

• Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Personal wellness support • Smart healthcare decision support • Occasional travel to Humana offices for training or meetings