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Grievance & Appeals Representative 3

Expired Job

Humana Inc. Tempe , AZ 85280

Posted 2 months ago

Description

The Grievances & Appeals Representative 3 manages client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills.

Responsibilities

The Grievances & Appeals Representative 3 assists members, to further/support quality related goals. Investigates and resolves member and practitioner issues. Decisions are typically focus on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, and works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge.

Required Qualifications

  • High School Diploma or equivalent

  • 1+ years of customer service 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

  • Must be able to work Monday Friday 8 - 5 but be flexible with your hours based on business needs to work possible overtime

  • Previous experience in the healthcare or medical fields

Preferred Qualifications

  • Associate's or Bachelor's Degree

  • Previous inbound call center or related customer service experience

  • 1-3 years of grievance and appeals experience

  • Previous experience processing medical claims

  • Prior experience with Medicare

  • Experience with the Claims Administration System (CAS)

  • Knowledge of medical terminology

  • Ability to manage large volume of documents including tracking, copying, faxing and scanning

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

Additional Information

Scheduled Weekly Hours
40


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Grievance & Appeals Representative 3

Expired Job

Humana Inc.