**Description** 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 Grievance & Appeals Representative 3 role. **Responsibilities** **What we need your help with:** + You will manage 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. **COME GROW WITH HUMANA! BENEFITS DAY ONE - STELLAR 401K MATCH - PAID TIME OFF** **What you need for success! - Required Qualifications** + 2+ years working with customers in a fast-paced, deadline-oriented environment + High School Diploma or GED + Prior experience interpreting Member Benefits and Medical Claims + Experience with case management or the ability to prioritize and manage inventory and work flow + Strong attention to detail, organizational and time management skills with the ability to interpret, research and identify core issues + Strong customer focus, 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 **Work at Home 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. **What you need to be considered a Superstar! : Preferred Qualifications** + Associate's or Bachelor's Degree + Prior experience with Humana's operating systems: MHK (MedHok), SRO / CAS / ARGUS, CI, CGX + Prior Medicare experience + Prior experience with CMS Guidelines and remaining compliant + High level of emotional intelligence with a proven ability to influence office culture and engagement in a positive manner **Additional Information** + Flexibility - ability to work overtime including weekends, based on business needs + Department Hours- **Shift could fall between business hours of 6:00am to 6:00 pm EST** . Hours subject to change based on business needs + **Training Hours - Training will start day one of employment and run the first 8 weeks with a schedule of 8am - 4:30 pm EST. Attendance is vital for success so little to no time off is allowed during training.** **Scheduled Weekly Hours** 40 <>
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