Grievance & Appeals Representative 3 Humana 4,424 reviews - Tempe, AZ Humana 4,424 reviews Read what people are saying about working here. Description The Grievances & Appeals Representative 3 manages client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills. Responsibilities The Grievances & Appeals Representative 3 assists members, to further/support quality related goals. Investigates and resolves member and practitioner issues. Decisions are typically focus on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, and works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge. Required Qualifications * High School Diploma or equivalent * 1+ years of customer service experience * Must have experience in the healthcare industry or medical field * Strong data entry skills required * Intermediate experience with Microsoft Word and Excel * Must have experience in a production driven environment * Must be able to work Monday Friday 8 - 5 but be flexible with your hours based on business needs to work possible overtime * Previous experience in the healthcare or medical fields Preferred Qualifications * Associate's or Bachelor's Degree * Previous inbound call center or related customer service experience * 1-3 years of grievance and appeals experience * Previous experience processing medical claims * Prior experience with Medicare * Experience with the Claims Administration System (CAS) * Knowledge of medical terminology * Ability to manage large volume of documents including tracking, copying, faxing and scanning * Excellent interpersonal skills with ability to sensitively and compassionately interact with geriatric population Additional Information Scheduled Weekly Hours 40 Humana - 18 hours ago - save job - original job Apply Now Apply On Company Site Save this job