Humana
Grievance and Appeals Representative
This job is now closed
Job Description
- Req#: R-328220
Louisville, KY
Tampa, FL
San Antonio, TX
Green Bay, WI
2+ years of customer service experience
Must have experience in the healthcare industry or medical field
Strong data entry skills
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
Virtual training will begin March 25th , 2024, and runs for 5 weeks with a schedule of 8:00 am – 4:30 pm EST, Monday – Friday.
Please note that training is a critical stage of associate development. Attendance is vital for your success, so no time off, other than observed holidays, is allowed during training.
New Hire Training requires you to be appropriately dressed, on time and on camera via the facilitated Zoom classroom instruction for attendance.
Once out of training, you must be available to work either one of these schedules:
Sunday – Thursday 10:30 AM- 7:00PM EST
Tuesday - Saturday 10:30 AM- 7:00PM EST
Associate's or Bachelor's Degree
Previous inbound call center or related customer service experience
Grievance and appeals experience
Bilingual (English and Spanish); with the ability to read, write, and speak English and Spanish
Prior experience with Medicare
Experience with the Clinical Guidance Exchange, CGX 2.0
Knowledge of medical terminology
Ability to manage large volume of documents including tracking, copying, faxing and scanning
Excellent interpersonal skills with ability to interact with geriatric population sensitively and compassionately
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.
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.
Become a part of our caring community and help us put health first
The Grievances & Appeals Representative 3 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. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills.
The Grievances & Appeals Representative 3 assists members, via phone or face to face, further/support quality related goals. Investigates and resolves member and practitioner issues. Decisions are typically focused on methods, tactics, and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes, and techniques . Also works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge.
Use your skills to make an impact
We are only considering candidates who live within 50 miles and/or 1 hour of one of the following Humana locations:
Required Qualifications
Required Work Schedule:
Training :
Work Hours :
(Mandatory Overtime and business need for inventory, may include weekend days and holidays. Hours are subject to change based on business needs but are always communicated ahead of the need.)
Grievances and Appeals (G&A) has an impact to our business and because of the complexities of our work, there is an 18-month commitment to this department. G&A will not allow transitions outside of area prior to the end of the 18 months .
Preferred Qualifications
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:
Interview Process
Scheduled Weekly Hours
40
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.
About us
Equal Opportunity EmployerIt 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.
About the company
Humana looks at every facet of your life and works with you to create a path to health that fits your unique needs