Bethesda, MD, United States
Operations, Work At Home, Customer Service
Aug 23, 2021
The 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.
Must 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 required
1-3 years of customer service experience
Strong proficiency with Microsoft Word and Excel
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Associate's or Bachelor's Degree
Experience with electronic inventory management - able to complete assigned cases in a specified time frame.
Experience in a production driven environment
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
Bilingual (English and Spanish); with the ability to read, write, and speak English and Spanish
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 10x1 (10mbs download x 1mbs upload) for optimal performance of is required
Scheduled Weekly Hours
Website : http://www.humana.com