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Grievances and Appeals Representative 4 - Work at Home/Remote EST and CST

Humana

Location: Tampa, FL 33603
Type: Remote
Posted on: October 21, 2021
This job is no longer available from the source.
**Description** **Responsibilities** This position can be in office or work at home in EST or CST and will provide coverage for eastern time zone hours. **Weekend work required. Schedules will be from Thursday - Monday.** **5% Shift differential for working Saturday and Sunday** The Grievances & Appeals Representative 4 assists members, 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 Qualifications** + Must be able to work an 8 hour shift from Thursday through Monday. + Strong data entry skills required + 1-3 years of customer service experience + Strong proficiency with Microsoft Word and Excel + Must have experience in a production driven environment + Must be passionate about contributing to an organization focused on continuously improving consumer experiences **Preferred Qualifications** + Associate's or Bachelor's Degree + Experience with electronic inventory management - able to complete assigned cases in a specified time frame. + Previous inbound call center or related customer service experience + 2 - 4 years of grievance and appeals experience + CAS, PAHub and MedHOK experience strongly preferred + Previous experience processing medical claims **Additional Information** Work at Home/Remote Requirements Must ensure designated work area is free from distractions during work hours and virtual meetings Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 25x10 (25mbs download x 10mbs upload) for optimal performance of is required **Scheduled Weekly Hours** 40 <>
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