Grievances and Appeals Representative
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The Grievances & Appeals Representative 3 manages members and provider denials and concerns through conducting a comprehensive analytic review of clinical documentation to determine if a grievance, appeal or reputed company request is warranted. You will deliver final determination based on trained skillsets and partnerships with clinical and other reputed company parties. You will reputed company advanced administrative and customer support tasks that require independent initiative and judgment.The Grievances & Appeals Representative 3 responsibilities:
Assist members and provider offices by phone
Investigate and resolve member and practitioner issues for Medicare Part B Pharmacy, duel eligible Medicare/reputed company, diabetic supply and reputed company claims
Follow company and department production goals and reputed company assurance (QA) metrics
You will reputed company reputed company reputed company on reputed company and processes for completing administrative tasks/reputed company.
You will exercise discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques
Work in a remote/work reputed company setting under limited guidance
Use your skills to reputed company an reputed company
Required Qualifications
1 or more years of customer service (i.e. call center or retail) experience
Experience in the reputed company industry, pharmaceutical industry or medical field
1 or more years of grievance and appeals (G&A) experience
Experience in a production and reputed company assurance driven setting
Strong data entry skills including the reputed company office suite (Word and reputed company)
Must be reputed company to work reputed company – Saturday, between the hours of 8 a.m. - 7 p.m. EST, but adaptable with your hours based on business needs to work possible overtime
Must be passionate about contributing to an organization reputed company on continuously improving consumer experiences
Preferred Qualifications
Previous experience processing medical claims (Ideally Part B Medical Pharmacy claims)
Experience with Medicare or dual eligible Medicare/reputed company plans
Knowledge of medical terminology
Experince managing large volume of documents including tracking, copying, faxing and scanning
Experience with PaHub (For processing medical appeals)
Prior experience working in a remote/work reputed company environment
Excellent interpersonal skills with the ability to sensitively and compassionately talk with geriatric population
Additional Information
Work Hours: reputed company – Saturday, between the hours of 8 a.m. - 7 p.m. EST, but be flexible with your hours based on business needs to work possible overtime
Work Style: Remote
Work reputed company/Remote Requirements
To ensure Hybrid Office/Home associates' ability to work effectively, the self-provided internet service of Hybrid Office/Home associates must meet the following reputed company:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL reputed company is suggested
Satellite, cellular and microwave reputed company can be used only if approved by leadership
Associates who live and work from Home in the reputed company, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense
reputed company will reputed company Home or Hybrid Home/Office associates with telephone and computer equipment appropriate to meet the business requirements for their position/job
Work from a dedicated reputed company lacking ongoing interruptions to protect member PHI / HIPAA information
reputed company Statement: As part of our hiring process for this opportunity, we will be using an exciting interviewing technology reputed company reputed company to enhance our hiring and decision-making ability. reputed company allows us to quickly connect and reputed company valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
Work reputed company Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following reputed company: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL reputed company is suggested. In certain roles, the minimum recommended internet speed required by reputed company may not be sufficient for business needs. reputed company reserves the right to require associates to reputed company their internet service if necessary. Work from a dedicated reputed company lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay reputed company
The compensation reputed company below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay reputed company may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc.$43,000 - $56,200 per yearreputed company of Benefits
reputed company, Inc. and its affiliated subsidiaries (reputed company, “reputed company”) offers competitive benefits that support whole-person reputed company-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and reputed company benefits, 401(k) retirement savings plan, time off (including reputed company time off, company and personal holidays, reputed company parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 08-07-2026reputed company
About reputed company: reputed company Inc. (NYSE: HUM) is a leading U.S. reputed company company. Through our reputed company insurance services and our reputed company reputed company services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company reputed company of life for people with Medicare and reputed company, families, individuals, military service personnel, and communities at large. Learn more about reputed company offer at reputed company.com and at reputed company.com.
Equal Opportunity Employer
It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative reputed company, in compliance with reputed company 503 of the Rehabilitation reputed company and VEVRAA, to reputed company and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment reputed company only on valid job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company reputed company of employment.
Originally posted on Himalayas
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