Grievances & Appeals Representative 2 - Medicaid

📋 Description

• • The Grievances & Appeals Representative 2 role at Humana is critical to ensuring timely and accurate processing of Medicaid and AIP (dual) expedited cases, directly impacting member satisfaction and compliance with healthcare regulations.
• • Day to day, the representative will review and evaluate several cases per hour, identify valid expedited cases, conduct analytic reviews of clinical documentation, make outbound calls to members or providers, monitor multiple workstreams, adapt to process changes, and communicate issues to leadership.
• • Humana is a leading U.S. healthcare company dedicated to improving health outcomes for millions through its insurance and CenterWell services, with a strong commitment to equity, inclusion, and whole-person well-being.
• • In this role, you will develop expertise in Medicaid and Medicare grievance and appeals processes, strengthen analytical and communication skills, gain experience with healthcare systems like MHK and CGX, and build a foundation for advancement in healthcare operations or patient advocacy.