Grievance & Appeals Rep
Remote Nationwideremote$43K – $56K
Posted today · via Workday
About this role
Become a part of our caring community The Grievances & Appeals Representative 3 manages client denials and concerns. We do this by conducting a comprehensive analytic review of clinical documentation to determine if an appeal, grievance, or further request is warranted. Then, the representative delivers a final determination based on trained skillsets or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support tasks that require independent initiative and judgment. The Grievances & Appeals Representative 3 assists members, by phone or face-to-face, further/support quality related goals. Investigate and resolve member and practitioner issues.…
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: less, monday, 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.
lessmondayhipaa