IRT Appeals Representative - Remote

Overview

The Appeals Representative 4 - IRT investigates and resolves member and practitioner issues by managing client denials and conducting comprehensive reviews of clinical documentation.

In Short

• Investigate and resolve member and practitioner issues.
• Conduct analytic reviews of clinical documentation.
• Manage client denials and concerns.
• Work remotely with coverage for Eastern time zone hours.
• Training starts virtually for 4-6 weeks.
• Must work any 8-hour shift between 8am-7pm EST post-training.
• Attendance is critical, with no time off during training.
• Requires 18-month commitment to the department.
• Occasional travel to Humana's offices may be required.
• Compensation ranges from $48,300 to $65,900 per year.

Requirements

• 2+ years of Appeals experience.
• 1+ year of Healthcare experience.
• Strong data entry skills.
• Intermediate proficiency in Microsoft Word and Excel.
• Experience with electronic inventory management preferred.
• Ability to maintain confidentiality and work independently.
• Previous experience processing medical claims is a plus.
• Associate or Bachelor's Degree preferred.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off including holidays and volunteer time.
• Short-term and long-term disability.
• Life insurance and various opportunities for personal wellness.