Humana
10,000+ employees
Founded 1961
🏥 Healthcare
🛡️ Insurance
⚕️ Healthcare Insurance
Healthcare • Insurance • Healthcare Insurance
Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.
Grievance & Appeals Representative
🕒 August 14
🇺🇸 United States – Remote
💵 $40k - $52.3k / year
⏰ Full Time
🟡 Mid-level
🟠 Senior
🦅 H1B Visa Sponsor
👻 Ghost score 43%
Where this job comes from
Posted on Humana's careers page, not through a job board
First seen by Remote Rocketship August 14
Humana
10,000+ employees
Founded 1961
🏥 Healthcare
🛡️ Insurance
⚕️ Healthcare Insurance
Healthcare • Insurance • Healthcare Insurance
Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.
📋 Description
• Manage client denials and concerns through comprehensive analytic review of clinical documentation • Determine whether a grievance, appeal, or further request is warranted • Deliver final determinations using trained skillsets and partnerships with clinical and other Humana parties • Support members and providers with grievance and appeal inquiries • Investigate and resolve member and practitioner concerns • Document interactions and maintain accurate records • Explain processes, policies, and resolution outcomes • Research issues and gather information to support case resolution • Apply departmental policies and procedures • Prioritize workload and manage tasks to meet service expectations • Collaborate with internal teams on complex issues • Escalate concerns requiring additional review or action • Support quality, compliance, and member experience goals • Perform computations and moderately complex administrative, operational, and customer support assignments
🎯 Requirements
• Previous customer service experience • Previous experience in the healthcare industry or medical field • Experience in a production driven environment • Intermediate experience with Microsoft Word and Excel • Ability to work an 8-hour shift Monday–Friday between 8am–8pm • Flexibility to work overtime based on business needs • Passion for continuously improving consumer experiences • Associate's or Bachelor's Degree (preferred) • Previous experience in medical claims processing (preferred) • Previous inbound call center or related customer service experience (preferred) • 1–3 years of grievance and appeals experience (preferred) • Medical terminology experience (preferred) • Bilingual English and Spanish, with ability to read, write, and speak both (preferred) • Prior experience with Medicare (preferred) • Experience with the Claims Administration System (CAS) (preferred) • Knowledge of medical terminology (preferred) • Ability to manage large volumes of documents, including tracking, copying, faxing, and scanning (preferred) • Excellent interpersonal skills for sensitively interacting with the geriatric population (preferred) • For home work: minimum 25 Mbps download and 10 Mbps upload internet service • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information
🏖️ Benefits
• Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Remote work arrangement • Occasional travel to Humana offices for training or meetings • Home office internet requirements and dedicated workspace guidance
Apply Now📊 Check your resume score for this job
Improve your chances of getting an interview by checking your resume score before you apply.
Similar Jobs
🕒 August 14
Logistics Representative coordinating outbound shipments, warehousing, and customer deliveries for Actylis, a global sourcing and manufacturing solutions provider. Managing logistics partners, performance indicators, customs, and Incoterms.
🕒 August 13
Property claims representative handling complex building and structure claims for Capital Insurance Group, a West Coast property and casualty insurer. Investigating, negotiating, auditing, and mentoring claims staff.
🕒 August 13
Retail merchandiser stocking and selling convenience-store products for Max Distributing, a national U.S. distributor. Visiting stores, taking orders, resetting displays, and reporting service visits via mobile app.
🕒 August 13
Retail Route Representative merchandising and delivering products for Max Distributing, a national convenience-store distributor. Managing store visits, inventory, displays, invoicing, and route documentation independently.
🕒 August 12
Senior Enrollment Representative supporting Medicare enrollment, reconciliation, and benefits coordination for a leading medical institution. Analyzing enrollment data and assisting process improvement initiatives.
