Grievances amp Appeals Representative 3 FULLY BILINGUAL English/Spanish Remote anywhere with-in Eastern Time Zone Open

Profile

Description

The Bilingual Grievances & Appeals Representative 3 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 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills.

How we Value You

Benefits starting day 1 of employment

Competitive 401k match

Generous Paid Time Off accrual

Tuition Reimbursement

Parent Leave

Go365 perks for well-being

Responsibilities

This role is Remote, you must reside anywhere within Eastern Time Zone (Open)

Do you like work with members and providers to investigate and resolve grievance and appeal?

Respond to complaints, grievances and appeals in a consistent fashion, adhering to all regulatory, accreditation and internal processing timelines and guidelines:

Collect, analyze and interpret trend information to address and resolve non-routine business-related concerns

Fast growing department with opportunities for growth within the department and company, competitive salary and annual bonus and raises, and a 4% Associate Incentive Plan (AIP) based on company and individual goals and objectives

Required Qualifications

1 years of experience analyzing and solving customer problems, OR 1 years of work experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools

1 years' experience in the Healthcare industry or Medical field (Production Goal oriented environment)

Strong Data entry and Writing skills

Excellent interpersonal skills with ability to sensitively and compassionately interact with geriatric population

Fully Bilingual English/Spanish. Must be able to speak, read and write in both languages without limitations or assistance.

WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

Associate's or Bachelor's Degree highly preferred

1 or more years of Call Center or High Volume/Metric driven environment.

Prior job experience working with assigned cases with specific time-frames to resolve

Grievance and Appeals or Utilization Review experience

Additional Information

Schedule : Must be able to work Monday - Friday 8:00 am - 5:00 pm, Saturday rotation 8:00 am-5:00 pm. Flexible with your hours based on business needs to work possible overtime

Grievance & Appeal Assessment: After submitting your application, if you are selected to move forward you will receive an email to complete the Grievance and Appeals Assessment. This is an online activity where you will be asked to answer questions and learn more about Grievance and Appeals jobs at Humana. Most people complete the assessment in 10 to 15 minutes. You can complete the assessment on your phone, tablet or computer (Take your time completing this assessment). Your answers will be reviewed and you will subsequently be informed if you will be moving forward to the interview stage.

Language Proficiency Testing: Any Humana associate who speaks with a member in a language other than Spanish and/or English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.

Work Location (Address) : Remote (Anywhere with Eastern Time Zone)

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com