Job Description:

The 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.

Job Responsibilities:

Satellite and Wireless Internet service is NOT allowed for this role.
WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office.
Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.

Job Requirements/Qualifications:

Great with laptop computers, cell phones and the ability to navigate mobile apps. This also includes knowledge of Microsoft Word, Excel, Outlook and Power Point
Active Health Insurance license or ability to obtain
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Strong organizational, interpersonal, communication and presentation skills
Ability to build community relationships, driving self-generated sales and meeting sales goals and metrics while working independently
This role is part of Humana’s Driver safety program and requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100/300/100 limits
Must reside in the local territory