Grievances & Appeals Representative

This is a fully remote position, open to applicants in Alabama, +32 more states.

📋 Description

• Allocate cases to team members for submission to an external entity for second-level assessment.

• Track and document the number of cases assigned to the team.

• Oversee the distribution of cases among individual associates.

• Operate within set guidelines to fulfill work expectations and maintain quality standards.

• Prioritize tasks and manage deadlines with minimal oversight.

• Adapt to changing processes and a fast-paced work environment.

• Conduct comprehensive reviews of clinical documentation to evaluate grievances, appeals, and additional requests.

• Provide final decisions through collaboration with clinical teams and other departments at Humana.

⛳️ Requirements

• Minimum of 1 year of experience in customer service.

• At least 1 year of experience in data entry.

• Experience in a production-oriented environment.

• Proficient in utilizing multiple Microsoft applications simultaneously, including Teams, SharePoint, and Excel.

• Ability to manage a high volume of inventory on a daily basis.

• Must reside in the Central or Eastern Standard Time Zone (CST or EST).

• Availability to work the designated training and post-training schedules.

• Previous experience in inbound call centers or related customer service roles is preferred.

• Prior experience with grievances and appeals is preferred.

• Familiarity with medical terminology is preferred.

• Bilingual in English and Spanish is preferred, with the ability to read, write, and speak both languages.

• Previous experience with Medicare is preferred.

🏝️ Benefits

• Medical, dental, and vision insurance.

• 401(k) retirement savings plan.

• Paid time off.

• Company and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability coverage.

• Life insurance.

• Remote work from home opportunities.

• Occasional travel to Humana offices for training or meetings.

• Dedicated workspace and internet requirements to facilitate remote work.