Job Description

**Become a part of our caring community and help us put health first** The Grievances & Appeals Representative 4 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if an 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 4 assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment. The Grievances & Appeals Representative 4 assists members, teammates and other management personnel via phone or face to face, further / support quality related goals. Investigates and resolves member and practitioner issues. Decisions are regarding the daily priorities for an administrative work group and/or external vendors including coordinating work activities and monitoring progress towards schedules / goals, and often oversees work of others and/or is the primary administrative owner of a main process, program, product, or technology. Works within broad guidelines with little oversight. **Use your skills to make an impact** **Virtual training will start date one and will run for the** **first 4-6 weeks with a schedule of Monday-Friday, 8:00am-4:30pm EST.** **You must be on time, dressed appropriately / camera ready, with your camera on during training and for other meetings required by leadership. Attendance is vital for success so no time off is allowed during training or within your first 120 days.** **Following training, you must be able to work any 8-hour shift between 8am-7pm EST. Shifts will include one weekend day (Saturday or Sunday).** **Required Qualifications** + 2 years of healthcare or insurance experience + Strong data entry skills required + 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 **Preferred Qualifications** + Associate's or Bachelor's Degree + Previous inbound call center or related customer service experience + 1 year of leadership experience + 2 years of grievance and appeals experience + Previous experience processing medical claims + Bilingual (English and Spanish); with the ability to read, write, and speak English and Spanish **Additional Information** **Work at Home Guidance** To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: · 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. · Associates 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 associates 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. **Interview Process** As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. · **Text 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. · **Video Prescreen** : If you are successful with your text screen, you will receive another communication to record a Video Prescreen. This is an online video activity using 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. · **Offers** : Finalists from the interview will be contacted by a 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. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $48,300 - $65,900 per year **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. **About us** 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. ​ **Equal Opportunity Employer** It 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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our

Job Tags

Weekly pay, Holiday work, Full time, Temporary work, Apprenticeship, Remote job, Home office, Shift work, Sunday, Saturday, Monday to Friday,

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