Appeals Rep
Remote Kentuckyremote$48K – $66K
Posted today · via Workday
About this role
Become a part of our caring community The Appeals Representative 4 is responsible for managing appeal denials, by reviewing clinical documentation, determining whether further action is needed, and validating final determinations in coordination with clinical and internal Humana partner. You will report to a Supervisor, Grievances & Appeals. As the Appeals Representative 4 you will Managed Level 1 appeal cases, ensuring accuracy, completeness, and compliance with CMS requirements. Reviewed clinical documentation to support appeal determinations and escalation decisions. Coordinated with clinical teams and internal partners to finalize appeal outcomes. Investigated and resolved member and provider issues with a focus on resolution.…
What we'd score you on
reqspace match rubricFive dimensions, recruiter-grade. Upload your resume and we'll generate a written explanation of where you fit and where the gaps are.
1
Skills match
For this role: monday, teams, hipaa
2
Level fit
We check your title trajectory against the seniority signal of the role.
3
Domain experience
Your work in the role's domain matters more than your years total. We weight recent and direct experience.
4
Recency
A skill you used last quarter weighs more than one from five years ago. We grade on recency, not lifetime.
5
Location fit
This role is remote-eligible — we factor in your stated location and time-zone overlap.
Score yourself on this role.
Free · no card · written explanation included
Skills in this role
Pulled from the job description. These are the keywords we'll weight when scoring your fit.
mondayteamshipaa