What are the responsibilities and job description for the Grievances & Appeals Representative 2 position at Humana?
Become a part of our caring community and help us put health first
The Grievances & Appeals Representative 2 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if an a grievance, appeal or further request is warranted and then delivers final determination based on trained skillsets and / or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 2 performs varied activities and moderately complex administrative / operational / customer support assignments. Performs computations. Typically works on semi-routine assignments.
The Grievances & Appeals Representative 2 assists members, via phone or face to face, further / support quality related goals. Investigates and resolves member and practitioner issues. Decisions are typically focus on interpretation of area / department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization / timing, andworks under minimal direction. Follows standard policies / practices that allow for some opportunity for interpretation / deviation and / or independent discretion.
Use your skills to make an impact
Required Qualifications
Less than 3 years of customer service experience
Previous experience in the healthcare industry or medical field
Must have experience in a production driven environment
Intermediate experience with Microsoft Word and Excel
Strong data entry skills required
Must have experience in the healthcare industry or medical field
Strong data entry skills required
Must have experience in a production driven environment
Must be available Sunday - Saturday and available for multiple different shifts that are determined by the business need. This does include at time overtime.
Previous experience in the healthcare or medical fields
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
Associate's or Bachelor's Degree
Previous experience in medical claims processing
Previous inbound call center or related customer service experience
1 - 3 years of grievance and appeals experience
Medical terminology experience
Bilingual (English and Spanish); with the ability to read, write, and speak English and Spanish
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
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
40,000 - $52,300 per year
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline : 02-28-2025
About us
Humana Inc. (NYSE : HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our
Salary : $40,000 - $52,300
