Opportunity Description
**Become a part of our caring community**
The Grievances & Appeals Representative 3 manages members and provider denials and concerns through conducting a comprehensive analytic review of clinical documentation to determine if a grievance, appeal or further request is warranted. You will deliver final determination based on trained skillsets and partnerships with clinical and other Humana parties. You will perform advanced administrative and customer support tasks that require independent initiative and judgment.
The **Grievances & Appeals Representative 3 responsibilities:**
+ Assist members and provider offices by phone
+ Investigate and resolve member and practitioner issues for Medicare Part B Pharmacy, duel eligible Medicare/Medicaid, diabetic supply and related claims
+ Follow company and department production goals and quality assurance (QA) metrics
+ You will make decisions focused on methods and processes for completing administrative tasks/projects.
+ Yo...
The Grievances & Appeals Representative 3 manages members and provider denials and concerns through conducting a comprehensive analytic review of clinical documentation to determine if a grievance, appeal or further request is warranted. You will deliver final determination based on trained skillsets and partnerships with clinical and other Humana parties. You will perform advanced administrative and customer support tasks that require independent initiative and judgment.
The **Grievances & Appeals Representative 3 responsibilities:**
+ Assist members and provider offices by phone
+ Investigate and resolve member and practitioner issues for Medicare Part B Pharmacy, duel eligible Medicare/Medicaid, diabetic supply and related claims
+ Follow company and department production goals and quality assurance (QA) metrics
+ You will make decisions focused on methods and processes for completing administrative tasks/projects.
+ Yo...
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