# Grievances & Appeals Representative 2

**Company**: Humana Inc.
**Location**: Remote Nationwide
**Work arrangement**: remote
**Job type**: full-time
**Salary**: $40,000 - $52,300 per year
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://humana.wd5.myworkdayjobs.com/en-US/Humana_External_Career_Site/job/Remote-Nationwide/Grievance---Appeals-Representative_R-426500?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_00643808-53a

## Description

The Grievances & Appeals Representative 2 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if 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.

Responsibilities:

- Assist 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 to assigned work.

- Prioritize workload and manage tasks to meet service expectations.

- Collaborate with internal teams to resolve complex issues.

- Escalate concerns requiring additional review or action.

- Support quality, compliance, and member experience goals.

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 the hours of 8am-8pm with flexibility to work overtime based on business needs

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)

- Prior experience with Medicare

- Experience with the Claims Administration System (CAS)

- Knowledge of medical terminology

- Ability to manage large volume of documents

- Excellent interpersonal skills

Additional Information:

- Work from home requirements: minimum download speed of 25 Mbps and upload speed of 10 Mbps, dedicated workspace

- Occasional travel to Humana's offices for training or meetings may be required

Scheduled Weekly Hours: 40 Pay Range: $40,000 - $52,300 per year

Benefits:

- Medical, dental, and vision benefits

- 401(k) retirement savings plan

- Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)

- Short-term and long-term disability

- Life insurance

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## Skills

### Required
- customer service
- healthcare experience
- Microsoft Word
- Excel
- production-driven environment
- Spanish

### Nice to have
- medical claims processing
- inbound call center
- grievance and appeals experience
- medical terminology
- bilingual
- Medicare
- Claims Administration System (CAS)

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Source: [Apply at humana.wd5.myworkdayjobs.com](https://humana.wd5.myworkdayjobs.com/en-US/Humana_External_Career_Site/job/Remote-Nationwide/Grievance---Appeals-Representative_R-426500?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)