Appeals Rep

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.…