Grievances and Appeals Representative

🔥 0 minutes ago

🏄 California, Illinois, +2 more states – Remote

🏄 California – Remote 🌽 Illinois – Remote 🦬 Montana – Remote 🗿 South Dakota – Remote

💵 $43k - $56.2k / year

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

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Humana

WebsiteLinkedInAll Job Openings

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

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

🎯 Requirements

• 1 or more years of customer service (i.e. call center or retail) experience • Experience in the healthcare industry, pharmaceutical industry 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) • Must be able to work Sunday – Saturday, between the hours of 8 a.m. - 7 p.m. EST, but adaptable with your hours based on business needs to work possible overtime • Be passionate about contributing to an organization focused on continuously improving consumer experiences

🏖️ 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 and many other opportunities