Full Time
Louisville, KY
Posted 2 years ago

Humana

The Grievances & Appeals Representative 4 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if an a grievance, appeal or further request is warranted and then delivers final determination based on trained skillsets and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 4 assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment.

Responsibilities

Ready for a new challenge?

The Grievances & Appeals Representative 4 assists department associates, via phone or face to face, further/support quality related goals. Investigates and resolves member and practitioner issues. Decisions are regarding the daily priorities for an administrative work group and/or external vendors including coordinating work activities and monitoring progress towards schedules/goals, and often oversees work of others and/or is the primary administrative owner of a main process, program, product or technology. Works within broad guidelines with little oversight.

Medicare Advantage Post Appeal Case File Assignment (assigns cases to associates)
Monitor the Waiver of Liability operational workflow for compliance concerns

What you need for success! Required Qualifications

High School Diploma or equivalent
Minimum of 2 years of customer service experience
Minimum of 1 year of project leadership experience
Must have experience in the healthcare industry or medical field
Strong data entry skills required
Intermediate experience with Microsoft Word and Excel
Must have experience in a production driven environment

What you need to STAND OUT in the crowd! Preferred Qualifications

Associate’s or Bachelor’s Degree
Previous inbound call center or related customer service experience
Previous experience processing medical claims
Bilingual (English and Spanish); with the ability to read, write, and speak English and Spanish

Additional Information

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes.

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time.

Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible.

Scheduled Weekly Hours

Not Specified