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Grievances & Appeals representative

Humana
Saint Paul, MN
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**Become a part of our caring community and help us put health first**The ...
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Summary
About the job:
G&A rep 3 investigates and resolves grievances and appeals submitted by members and providers. Exercises discretion and judgement in prioritizing cases and interpreting procedures and processes. Works under limited guidance and has excellent critical thinking skills. The rep will manage client denials and concerns by conducting a comprehensive analytic review of documentation to determine if a grievance, appeal, or further request is warranted and then delivers final determination based on trained skillsets and/or...
Location:
Saint Paul, MN
Job Type:
Full-Time
Permanent
Occupation:
Human Resources Specialists
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information

HR Solutions Partner; Primary Care Organization

Humana
Saint Paul, MN
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**Become a part of our caring community and help us put health first**The HR ...
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Summary
About the job:
Solutions Partner 2 supports the human resources function in the implementation and execution of effective human resource policies and practices which help the assigned client group achieve their business results. The HR Solutions Partner 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.This role will be aligned to the Primary Care Organization.The HR Solutions Partner 2 provides expertise through HR consulting and coaching...
Location:
Saint Paul, MN
Job Type:
Full-Time
Permanent
Occupation:
Human Resources Specialists
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Call Center and Claims Representative

Humana
Saint Paul, MN
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**Become a part of our caring community and help us put health ...
Details
Summary
About the job:
first**Humana/iCare is seeking a Call Center and Claims Representative to meet the needs of members, potential enrollees and providers by providing a resource by phone to answer inquiries related to benefits, eligibility, claims, and perform other duties as assigned.The Call Center and Claims Representative works in a call center setting and provides program, benefit, eligibility, and claims information and describes Humana/iCare services to existing, potential and new members via telephone and in writing. This role will also...
Location:
Saint Paul, MN
Job Type:
Full-Time
Permanent
Occupation:
Customer Service Representatives
Career Level / Education:
High school diploma or equivalent
Salary:
Middle Income Jobs ($30K-$49K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information

HR Solutions Partner; Primary Care Organization

Humana
Columbus, OH
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**Become a part of our caring community and help us put health first**The HR ...
Details
Summary
About the job:
Solutions Partner 2 supports the human resources function in the implementation and execution of effective human resource policies and practices which help the assigned client group achieve their business results. The HR Solutions Partner 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.This role will be aligned to the Primary Care Organization.The HR Solutions Partner 2 provides expertise through HR consulting and coaching...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Human Resources Specialists
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Grievances & Appeals representative

Humana
Columbus, OH
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**Become a part of our caring community and help us put health first**The ...
Details
Summary
About the job:
G&A rep 3 investigates and resolves grievances and appeals submitted by members and providers. Exercises discretion and judgement in prioritizing cases and interpreting procedures and processes. Works under limited guidance and has excellent critical thinking skills. The rep will manage client denials and concerns by conducting a comprehensive analytic review of documentation to determine if a grievance, appeal, or further request is warranted and then delivers final determination based on trained skillsets and/or...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Human Resources Specialists
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information

Call Center and Claims Representative

Humana
Columbus, OH
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**Become a part of our caring community and help us put health ...
Details
Summary
About the job:
first**Humana/iCare is seeking a Call Center and Claims Representative to meet the needs of members, potential enrollees and providers by providing a resource by phone to answer inquiries related to benefits, eligibility, claims, and perform other duties as assigned.The Call Center and Claims Representative works in a call center setting and provides program, benefit, eligibility, and claims information and describes Humana/iCare services to existing, potential and new members via telephone and in writing. This role will also...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Customer Service Representatives
Career Level / Education:
High school diploma or equivalent
Salary:
Middle Income Jobs ($30K-$49K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information

Credentialing Auditing Assistant

Humana
Columbus, OH
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**Become a part of our caring community and help us put health first**As a ...
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Summary
About the job:
customer-centric company, our top priority has always been the health of the people we serve. Our decades of experience helping millions of members, and our continuous learning on how to meet their evolving needs, fuels our purpose and our passion for serving our customers.Credentialing Operations bonds the trust between patient and provider. Come join our organization and assist us in ensuring we continue to be a top choice for our members.The Credentialing Department reviews and verifies providers' credentials and...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Office and Administrative Support Workers, All Other
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
Certifications / Licenses:
National Committee for Quality Assurance
Workkeys
Applied Math
3
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Lead, Stars Member Engagement Strategy

Humana
Sacramento, CA
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Become a part of our caring community and help us put health first The ...
Details
Summary
About the job:
Health Quality and Stars team is seeking a Program Delivery Lead to drive advancement of innovation opportunities focused on member engagement to both optimize health outcomes for our members and sustain industry leading Stars performance. This leader will influence partners throughout our organization to co-develop shared objectives, creating alignment on strategic direction and prioritization of focus areas to drive the advancement of innovation opportunities. This individual has an in-depth understanding of how...
Location:
Sacramento, CA
Job Type:
Full-Time
Permanent
Occupation:
Management Analysts
Career Level / Education:
High school diploma or equivalent
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Pharmacy Claims Lead

Humana
Located in Ohio
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Full job description Become a part of our caring community and help us put ...
Details
Summary
About the job:
health first The Pharmacy Claims Lead - Financial Recovery leads a team that is responsible for monitoring pharmacy outstanding balances and recovering such balances in certain cases. The Pharmacy Claims Lead works on problems of diverse scope and complexity ranging from moderate to substantial. - The Pharmacy Claims Lead – Financial Recovery leads a team that is responsible for monitoring pharmacy outstanding balances, determining which cases require direct outreach to the pharmacies, and negotiating financial...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Business Operations Specialists, All Other
Career Level / Education:
High school diploma or equivalent
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
3
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information

Sales Field Agent

Humana
Baker, LA
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Full job description Become a part of our caring community and help us put ...
Details
Summary
About the job:
health first Are you passionate about the Medicare population, looking for an opportunity to work in sales, and wanting the ability to directly impact your own income potential? If so, we are looking for licensed, highly motivated, and self-driven individuals to join our team. In this field position, you will build community relationships, drive self-generated sales, and meet sales goals and metrics while working independently. You will be interacting with Humana’s customers, external business partners and the...
Location:
Baker, LA
Job Type:
Full-Time
Permanent
Occupation:
Insurance Sales Agents
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
Certifications / Licenses:
Life Insurance License
Driver's License
State insurance license
Workkeys
Applied Math
4
Graphic Literacy
5
Workplace Documents
5
apply
Detailed Job Information
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