Grievances & Appeals Representative

🔥 13 hours ago

🏈 Alabama, Connecticut, +31 more states – Remote

🏈 Alabama – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🌾 Nebraska – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote

💵 $40k - $52.3k / year

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Humana

WebsiteLinkedInAll Job Openings

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

• Assign cases to team members for submission to an independent entity for second-level review • Monitor and record the number of cases assigned to the team • Monitor distribution of cases among individual associates • Operate within established guidelines to meet work expectations and quality standards • Prioritize tasks and manage timelines with minimal supervision • Adapt to evolving processes and a fast-paced work environment • Perform thorough reviews of clinical documentation to assess grievances, appeals, and additional requests • Provide final determinations through collaboration with clinical and other Humana teams

🎯 Requirements

• Minimum of 1 year of customer service experience • Minimum of 1 year of data entry experience • Experience in a production-driven environment • Strong experience using multiple Microsoft systems simultaneously, including Teams, SharePoint, and Excel • Ability to manage large volume of inventory daily • Must reside in Central or Eastern Standard Time Zone (CST or EST) • Ability to work the specified training and post-training schedules • Previous inbound call center or related customer service experience preferred • Previous grievance and appeals experience preferred • Medical terminology experience preferred • Bilingual English and Spanish preferred, with ability to read, write, and speak both languages • Prior Medicare experience preferred

🏖️ Benefits

• Medical, dental, and vision benefits • 401(k) retirement savings plan • Paid time off • Company and personal holidays • Paid parental and caregiver leave • Short-term and long-term disability • Life insurance • Home-based remote work • Occasional travel to Humana offices for training or meetings • Dedicated work space and internet requirements to support work from home