Grievances and Appeals Representative
Location
California + 3 moreAll locations: California | Illinois | Montana | South Dakota
Posted
3 days ago
Salary
$43K - $56.2K / year
Seniority
Junior
Job Description
Grievances and Appeals Representative
Humana
• 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
Job 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
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