Become a part of our caring community and help us put health first
 

The Grievances & Appeals Professional 2 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 Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The Grievances & Appeals Professional 2 assists in the areas of member rights, formal appeals and grievances, informal complaint resolution, conflict mediation, and other areas of responsibility. Investigates and resolves member and practitioner issues. Exhibits the ability to work independently in an environment with multiple responsibilities, to prioritize tasks and to meet finite deadlines. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction. Requests guidance where needed. Follows established guidelines/procedures. Demonstrates a collegial team spirit and ability to work in collaboration with other staff and across multiple departments.

Use your skills to make an impact
 

Required Qualifications

• Bachelor's degree
• A minimum of three years working in the area of social work, human services, healthcare or medical field.  
• Strong communication skills, including the ability to adapt communication style to accommodate supporting individuals with differing needs and abilities.
• Advanced experience with Microsoft Word and Excel
• Experience handling multiple projects and assignments as directed by Management
• Capacity to maintain confidentiality and work independently in support of the department
• Passionate about contributing to an organization focused on continuously improving member experiences

Preferred Qualifications

• Experience in grievance and appeals processes
• Previous experience processing medical claims or knowledge of medical terminology
• One or more years experience working with individuals with Intellectual/Developmental Disabilities, Physical Disabilities or Frail Elders.
• Bilingual (English and Spanish); with the ability to read, write, and speak English and Spanish

Additional Information

WAH Internet Statement

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:

• 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.

Benefits

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

• Health benefits effective day 1
• Paid time off, holidays, volunteer time and jury duty pay
• Recognition pay
• 401(k) retirement savings plan with employer match
• Tuition assistance
• Scholarships for eligible dependents
• Parental and caregiver leave
• Employee charity matching program
• Network Resource Groups (NRGs)
• Career development opportunities

Modern Hire

As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire 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.

SSN Alert

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secur