Do you enjoy helping those in need? Do you love researching, analyzing medical documents to determine if something was missed? Have you ever considered yourself a detective for medical claims / member benefits? Well, if you answered yes to any of the above you may be a great fit for Humana’s Grievances & Appeals Representative 3 role.

Responsibilities

Responsibilities

What we need your help with:

• Manages client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted.
• Perform advanced administrative and/or customer support duties that require independent initiative and judgment.
• From time to time apply intermediate mathematical skills and regularly exercise discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques.
• Work under limited guidance at the comfort of your home due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge.

What you get from your great work!

Benefits and Perks of This Opportunity:

• Competitive compensation with strong hourly rate and bonus eligibility
• The ability to cut your daily commute to less than a minute!! Yes 100% Work at house capability.
• Extensive 100% virtual training program for the first 10 weeks setting you up for immediate and future success.
• Robust benefits as a full-time employee including health, dental, vision, tuition assistance, 401(k) and more. Effective first day – no waiting period!
• Professional development opportunities including career advancement and mobility, virtual learning platforms, networking opportunities through our network resource groups, mentoring programs and more

What you need for success! - Required Qualifications

• 2+ years working with customers in a fast-paced, deadline-oriented environment
• Prior experience interpreting Member Benefits and Medical Claims
• Experience with the ability to prioritize and manage inventory and workflow
• Customer focused, analytical and decision-making skills
• Strong technical skills with the ability to work across multiple software systems and comfortable work remote out of your home
• High level of emotional intelligence with a proven ability to influence office culture and engagement in a positive manner
• Flexibility - ability to work overtime including weekends, based on business needs
• Department Hours -8:00am - 4:30pm EST – during training and ramp up. Shift could then fall between start time of business hours of 6:00 am to 6:00 pm in the time zone you are located. Mandatory Overtime and business need for inventory, may include weekend days and holidays. Hours are subject to change based on business needs but are always communicated ahead of the need.
• High level of emotional intelligence with a proven ability to influence office culture and engagement in a positive manner
• Must live within 1 hour of the following locations: Louisville, KY; Tampa, Fl; San Antonio, TX; Green Bay, WI; San Juan, PR
• Position and training are Remote but are expected to visit/attend the office 1 to 2x/year

• Must meet all Work at home (WAH) requirements
• Training will start day one of employment and runs for 10 weeks with a schedule of 8:30 am – 4:00 pm EST, Monday - Friday. Attendance is vital for success, so no time off is approved
• Required attendance via Webcam for the entire training

What you need to be considered a Superstar! Preferred Qualifications

• Associate’s or bachelor’s degree
• Humana’s operating systems: MHK (MedHok), CCP/GCP/CAS, CI, CGX

Work at Home Requirements

To ensure associates’ ability to work effectively, the self-provided internet service of work at Home associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense
• Humana will provide work at Home associates with telephone equipment appropriate to meet the business requirements for their position/job
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

**PLEASE MAKE SURE YOU ATTACH YOUR RESUME TO YOUR APPLICATION (pdf or Word format) **

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information to the application at Humana’s secure website.

Steps for this job:

• Prescreen: Shortly after submitting your application, you will receive both a text message and email requesting you to complete 10 to 15 prescreen questions with either yes or no answers. The text message may arrive prior to the email. If you prefer to answer via computer or tablet, wait for the email.
• Assessment: If the prescreen is passed, you will receive another communication to take the Grievances and Appeals Assessment. This is an online activity where you will see a Realistic Job Preview to learn more about the job and then be asked to answer questions where 30 minutes should be set aside to complete. You can complete the assessment on your phone, tablet or computer; however, most candidates prefer using a computer or tablet.
• Interviews: Some candidates will be invited to interview. If so, the recruiter will reach out to schedule. A writing sample may or may not be required.
• Offers: Finalists from the interview will be contacted by the recruiter to discuss an offer for the job
• Note: Depending on the number of openings, the number of candidates who apply, and the schedules of interviewers and recruiters, this process may take several weeks or less; however, know that we are working hard to proceed as quickly as possible and to keep you informed.

Scheduled Weekly Hours

40