Grievances & Appeals Representative

Become a part of our caring community The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if a grievance, appeal or further request is warranted and then delivers final determination based on trained skillsets and/or partnerships with clinical and other Humana parties. You will perform advanced administrative/operational/customer support responsibilities that require independent initiative and judgment. Assist members by phone to further/support quality related goals. Investigate and resolve member and practitioner issues. Decisions typically focus on methods, tactics and processes for completing administrative tasks/projects.…