Grievances and Appeals Representative 4 - Work at Home/Remote CST/EST
Humana Inc.
Localização do trabalho
Charlotte, NC, United States
Detalhes sobre a oferta de trabalho
DescriptionResponsibilitiesThe Grievances & Appeals Representative 4 assists members, via phone or face to face, further/support quality related goals. Reviews the level 1 appeals cases and ensures that information is correct and then forwards to CMS entity for further review. 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 is the primary administrative owner of a main process, program, product or technology.Works within broad guidelines with little oversight.Required QualificationsMust be able to work an 8 hour shift. (Start time can be between 8 am and 9 am EST)Weekends required on rotating basis (also some holidays as needed)Strong data entry skills required1-3 years of customer service experienceStrong proficiency with Microsoft Word and ExcelMust be passionate about contributing to an organization focused on continuously improving consumer experiencesPreferred QualificationsAssociate's or Bachelor's DegreeExperience with electronic inventory management - able to complete assigned cases in a specified time frame.Experience in a production driven environmentPrevious inbound call center or related customer service experience2 - 4 years of grievance and appeals experienceCAS, PAHub and MedHOK experience strongly preferredPrevious experience processing medical claimsBilingual (English and Spanish); with the ability to read, write, and speak English and SpanishAdditional InformationWork at Home/Remote RequirementsMust ensure designated work area is free from distractions during work hours and virtual meetingsMust provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is requiredScheduled Weekly Hours40
