Address
Form of workBecome a part of our caring community and help us put health first
The Grievances & Appeals Representative 4 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 4 assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment.The Grievances & Appeals Representative 4 assists members, via phone or face to face, further/support quality related goals. Investigates and resolves member and practitioner issues. Decisions are regarding the daily priorities for an administrative work group and/or external vendors including coordinating work activities and monitoring progress towards schedules/goals, andoften oversees work of others and/or is the primary administrative owner of a main process, program, product or technology. Works within broad guidelines with little oversight.
Use your skills to make an impact
The training and shift schedule is Monday-Friday, 8am-5pm EST.
Required Qualifications
- 2 years of customer service experience
- Strong data entry skills required
- Intermediate experience with Microsoft Word and Excel
- Must have experience in a production driven environment
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
- Experience in the healthcare industry or medical field
- Associate's or Bachelor's Degree
- 2 years of grievance and appeals experience
- Previous experience processing medical claims
- Bilingual (English and Spanish); with the ability to read, write, and speak English and Spanish
Additional Information
Please be sure to include your resume with your application!
Work From Home:
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Interview Process
Prescreen: Shortly after submitting your application, you may receive both a text message and email requesting you to complete 10 to 15 prescreen questions with either yes or no answers. The text message may arrive prior to the email. If you prefer to answer via computer or tablet, wait for the email.
Assessment: If the prescreen is passed, you will receive another communication to take the Grievances and Appeals Assessment. This is an online activity where you will see a Realistic Job Preview to learn more about the job and then be asked to answer questions where 30 minutes should be set aside to complete. You can complete the assessment on your phone, tablet, or computer; however, most candidates prefer using a computer or tablet.
Interviews: Some candidates will be invited to interview. If so, the recruiter will reach out to schedule. A writing sample may or may not be required.
Offers: Finalists from the interview will be contacted by the recruiter to discuss an offer for the job
Note: Depending on the number of openings, the number of candidates who apply, and the schedules of interviewers and recruiters, this process may take several weeks or less; however, know that we are working hard to proceed as quickly as possible and to keep you informed.
Scheduled Weekly Hours
40Pay 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.$43,400 - $59,600 per year
Description of Benefits
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 because he or she is a protected veteran. 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.
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