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Grievances & Appeals Representative

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Humana

22d ago

  • Job
    Full-time
    Junior Level
  • Customer Relations
    Healthcare
  • United States
    Remote

AI generated summary

  • You need 2 years in customer service, healthcare experience, data entry skills, Microsoft Office proficiency, analytical abilities, and a distraction-free workspace for remote work.
  • You will analyze medical denials, support clients, prioritize tasks, and exercise judgment in navigating administrative processes, all while working independently from home.

Requirements

  • Two years of experience in customer service
  • Previous experience working in the healthcare and/or medical field
  • Excellent data entry capabilities
  • Proficiency with Microsoft Office, including intermediate skills in Outlook, Excel, and PowerPoint
  • Ability to adhere to process maps
  • Experience working in a fast-paced, production-oriented environment
  • Proven ability to prioritize tasks and manage inventory and workflow
  • Strong focus with keen analytical and decision-making abilities
  • Robust technical skills, including the capability to set up and connect a computer with additional monitors, navigate multiple software systems and applications simultaneously, and effectively work from home
  • Availability of a distraction-free workspace at home

Responsibilities

  • Managing client medical denials through a thorough analytical review of clinical documentation to assess the necessity of an appeal.
  • Performing advanced administrative and customer support tasks that demand independent initiative and judgment.
  • Occasionally applying intermediate mathematical skills and regularly exercising discretion and judgment in prioritizing tasks, interpreting, and adapting procedures, processes, and techniques.
  • Working under limited supervision from the comfort of your home due to your extensive experience and deep knowledge of administrative processes and organizational operations.

FAQs

What is the role of a Grievances & Appeals Representative 3?

The Grievances & Appeals Representative 3 manages client denials and concerns by conducting comprehensive analytic reviews of clinical documentation to determine if a grievance, appeal, or further request is warranted, delivering final determinations based on their skills and partnerships with clinical and other Humana parties.

What are the required working hours for this position?

The required working hours are Monday to Friday, 8 AM to 4:30 PM EST, both during training and after.

What is the training schedule for new hires?

Training will begin on day one of employment (tentatively January 12th, 2026) and lasts for 5 weeks with no time off allowed during this period.

What qualifications do I need to apply for this position?

Required qualifications include two years of experience in customer service, previous experience in the healthcare or medical field, excellent data entry capabilities, proficiency with Microsoft Office, and strong analytical and decision-making abilities.

Is a degree required for this role?

An associate or bachelor’s degree is preferred but not strictly required.

What technical skills are necessary for this position?

Candidates should have robust technical skills, including the ability to set up and connect a computer with additional monitors, navigate multiple software systems simultaneously, and work effectively from home.

Is there a restriction on applying to other Humana opportunities?

Yes, you must remain in this position for a period of eighteen (18) months before applying to other Humana opportunities.

How is the interview process structured for this position?

The interview process includes a Virtual Job Experience (VJE), a Video Prescreen, interviews with recruiters, and then offers for the job based on the interview results.

What is the salary range for this position?

The compensation range for this role is between $43,000 and $56,200 per year, depending on geographic location, skills, knowledge, experience, and education.

What benefits does Humana offer its employees?

Humana offers competitive benefits, including medical, dental, and vision benefits, a 401(k) retirement savings plan, paid time off, short-term and long-term disability, life insurance, and more.

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Humana

Science & Healthcare
Industry
1001-5000
Employees
1961
Founded Year

Mission & Purpose

At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.