Grievance and Appeals Representative

🔥 13 hours ago

🇺🇸 United States – Remote

💵 $48.3k - $65.9k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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• Open for 1 day.
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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

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

• Review Level 1 appeal cases for accuracy • Ensure case documentation is ready for Independent Review Entity (IRE) submission • Monitor case work for quality, accuracy, compliance, timely closure, and audit readiness • Review cases to identify trends and risks, escalating as needed • Support achievement of monthly operational and compliance metrics • Support the Medicare Internal Review Team • Help ensure cases are timely, meet Medicare compliance requirements, and are properly documented for external review • Support compliance tracking, audit readiness, and issue resolution for members and providers

🎯 Requirements

• 1+ year of healthcare or medical field experience • 2+ years of experience with Grievances and Appeals • Experience meeting expectations in a metrics driven environment • Must be able to work any 8-hour shift between 7am-7pm EST • Shifts will include one weekend day (Saturday or Sunday) • Must complete training Monday through Friday, 8:00 a.m.-4:30 p.m., for up to 6 weeks • Must have internet with at least 25 Mbps download and 10 Mbps upload speed • Wireless, wired cable, or DSL connection suggested • Must work from a dedicated space without ongoing interruptions to protect PHI/HIPAA information • Associate or bachelor's Degree • Prior leadership experience • Previous inbound call center or related customer service experience • Experience processing medical claims • Medicare experience

🏖️ 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

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